Abstract
This study aimed to evaluate contrast-enhanced mammography (CEM) accuracy and reproducibility in the detection and measurement of residual tumor after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients with calcifications, using surgical specimen pathology as the reference. Pre- and post-NAC CEM images of 36 consecutive BC patients receiving NAC in 2012–2020, with calcifications in the tumor bed at diagnosis, were retrospectively reviewed by two radiologists; described were absence/presence and size of residual disease based on contrast enhancement (CE) only and CE plus calcifications. Twenty-eight patients (77.8%) had invasive and 5 (13.9%) in situ-only residual disease at surgical specimen pathology. Considering CE plus calcifications instead of CE only, CEM sensitivity for invasive residual tumor increased from 85.7% (95% CI = 67.3–96%) to 96.4% (95% CI = 81.7–99.9%) and specificity decreased from 5/8 (62.5%; 95% CI = 24.5–91.5%) to 1/8 (14.3%; 95% CI = 0.4–57.9%). For in situ-only residual disease, false negatives decreased from 3 to 0 and false positives increased from 1 to 2. CEM pathology concordance in residual disease measurement increased (R squared from 0.38 to 0.45); inter-reader concordance decreased (R squared from 0.79 to 0.66). Considering CE plus calcifications to evaluate NAC response in BC patients increases sensitivity in detection and accuracy in measurement of residual disease but increases false positives.
Highlights
Neoadjuvant chemotherapies (NAC) aim at reducing the proportion of non-surgically treatable breast cancers and decreasing the need for mastectomy and/or axillary lymph node dissection [1,2,3]
The ductal carcinoma in situ (DCIS) component is frequently associated with pleomorphic and fine linear branching calcifications on mammography or area of enhancement on magnetic resonance imaging (MRI), on the latter especially when associated with high nuclear grade and comedonecrosis
All consecutive breast cancer patients followed by the provincial Breast Unit of Reggio Emilia who were treated with NAC from 2012 to 2020, who presented calcifications in the tumor bed at diagnosis, and who underwent contrast-enhanced mammography (CEM) at diagnosis and after NAC, were included in this study
Summary
Neoadjuvant chemotherapies (NAC) aim at reducing the proportion of non-surgically treatable breast cancers and decreasing the need for mastectomy and/or axillary lymph node dissection [1,2,3]. The antiangiogenetic effect of chemotherapeutic drugs, tends to reduce the enhancement of the residual neoplastic component in the tumor bed after NAC, while calcifications almost never disappear completely. For this reason, patients with calcifications in the tumor bed depicted in mammography have a higher probability of being false negative in the assessment of residual disease after NAC with MRI, which is currently considered the gold standard imaging tool in treatment monitoring but technically unable to detect calcifications [8,12,13]
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