Abstract P3-01-05: The Role of Mammographic Calcification in the Neo-adjuvant Therapy of Breast Cancer Imaging Evaluation

Abstract

Abstract Aim: To evaluate the relationship between malignant appearance of mammographic calcification and breast cancer pathological features, and to explore the predictive value of calcification appearances and morphology changes in neo-adjuvant setting. Methods: 419 patients with operable breast cancer received neo-adjuvant therapy between 2008.2 and 2011.8 in Shanghai Cancer Hospital. Core needle biopsy was conducted before preoperative therapy to determine cancer and achieve pathological features. Mammogram (MG), ultrasound and breast MRI were routinely done prior to therapy and prior to surgical operation. We conducted a detailed analysis of MG images in patients with malignant calcification, recorded the morphology, distribution, range, density, diameter and number of the calcification. Results: 419 patients enrolled, 108 patients (25.8%) showed malignant calcification in MG, 6 patients missed the first MG before therapy. 214 patients were Luminal A, 95 were Luminal B, 64 were Her2 positive and 46 were triple negative, the pCR rate was 14%, 30.5%, 53%, 43.5% respectively. Patients with malignant calcification have more ER positive (81.5% vs. 71.7%, p = 0.045) and HER2 positive (51.8% vs. 33%, p = 0.001) diseases. The pCR rate was 26% in patients with malignant calcification and 28% in patients without, p = 0.8. Different morphology shapes showed similar pCR rate, p = 0.89. Casting-type had a higher pCR rate 45.8%, compared with 20% in crushed stone-like and 16.7% in powderish, p = 0.031. Range more than 5cm had a higher pCR rate, 40.7% vs. 20%, p = 0.034. Density, diameter and number of the calcification did not reach statistical difference, however high density, diameter >1mm and number >20 per cm2 showed a trend of higher pCR rate. Patients with diameter ≤0.5mm had a higher lymphatic vascular invasive rate 51.4%, compared to diameter≤1mm (26.8%) and diameter >1mm (22.7%), p = 0.03. Morphology and distribution of calcification did not change obviously. Less than 30% patients showed changes in range, number or density, no relationship with pCR rate. Conclusion: Patients with malignant calcification are more likely to have ER positive and Her2 positive diseases. MG should be considered the standard prior to the start of therapy, the distribution and range of the calcification may predict pCR rate. Calcification appearance does not change significantly after neo-adjuvant therapy, therefore MG is not an appropriate method for efficacy evaluation. But MG before surgery is still useful to identify the extent of surgery, especially in breast conserve therapy. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-01-05.