Beatriz Adrada MD, Presenter: Nothing to Disclose

Deanna Lane MD, Abstract Co-Author: Nothing to Disclose

Elsa Maria Arribas MD, Abstract Co-Author: Nothing to Disclose

Erika Resetkova MD, Abstract Co-Author: Nothing to Disclose

Lei Huo MD, Abstract Co-Author: Nothing to Disclose

Wei Tse Yang MD, Abstract Co-Author: Nothing to Disclose

To correlate breast cancer calcifications before and after neoadjuvant therapy (NAT) with histopathology.

A database search from a single institution was performed of women with invasive ductal cancer (IDC) who had NAT between 1/1/2004 and 12/31/2008, and had pre- and post-treatment mammograms available for review. Of 494 women with IDC who underwent NAT, 106 had calcifications visible on pre-, post-, or pre and post treatment mammograms, and were included in the study. Age, clinical, mammographic, and histopathologic findings were reviewed. The presence, morphology, distribution, and size of calcifications (Per ACR BIRADS lexicon) were noted on pre- and post-treatment mammograms; and interval change in size of calcifications documented. Histopathology at diagnosis and final surgery was reviewed to determine (1) the association of calcifications in the cancer bed with invasive cancer (IC), ductal carcinoma in situ (DCIS), or benign findings, and (2) pathologic response.

The mean age of patients was 49 years, range 24-80 years. 38 patients had IDC, and 68 IDC plus DCIS. 76 were ER+, 61 PR+, 20HER2+, and 4 triple negative. 94 and 106 patients had calcifications associated with pre- and post-treatment mammograms respectively. The median size of pre-treatment calcifications was 4.0 cm, (range, 0-12 cm), and post-treatment calcifications was 3.5 cm, (range 0.2-12 cm); no significant change in calcification size with NAT (p=0.45). Calcifications decreased or were stable in 76 (72%), and increased or were new in 30 (28%) patients. Calcifications on pre-treatment mammograms were associated with IDC in 100% patients. Of 89 patients with available pre- and post-treatment mammograms with post-treatment cancer status, calcifications were associated with IDC in 19 (21%), DCIS in 30 (34%), and benign findings in 40 (45%). Pathologic complete response was observed in 32/106 (30%) patients.

This is the first study to directly correlate cancer related calcifications with pathology at diagnosis and mastectomy. The extent of calcifications after NAT may overestimate the extent of residual cancer in 50% of patients, which has implications on surgical planning for breast cancer patients.

Residual calcifications in the cancer bed after neoadjuvant therapy are frequently associated with benign findings, and may not be accurate for surgical planning.

Adrada, B, Lane, D, Arribas, E, Resetkova, E, Huo, L, Yang, W, The Significance of Residual Mammographic Calcifications after Neoadjuvant Therapy.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007121.html