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Breast Imaging

E3109. Mammographic Calcifications Before and After Neoadjuvant Chemotherapy

Narendra D,  Iyer R. University of Rochester Medical Center, Rochester, NY

Address correspondence to D. Narendra (divya_narendra@urmc.rochester.edu)

Background Information: Breast calcifications, which are best seen on mammography, may be the earliest sign of malignancy. Patients found to have locally advanced breast cancer typically receive neoadjuvant chemotherapy followed by surgery. The extent of surgical excision depends on the extent of residual disease after neoadjuvant chemotherapy.

Educational Goals/Teaching Points: We review the morphologies of suspicious calcifications and describe the rationale for neoadjuvant chemotherapy. Using a unique case from our institution in the context of the results of a recent publication by Kim et al. [1], we discuss the significance of increasing mammographic microcalcifications following neoadjuvant chemotherapy despite MRI findings consistent with response to treatment, and the impact this has on definitive surgical treatment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We provide mammographic images of suspicious calcification morphologies, including amorphous, coarse heterogeneous, fine pleomorphic, and fine linear or linear branching. We present mammographic and MR images obtained before and after neoadjuvant chemotherapy for a patient with invasive ductal carcinoma of the left breast who underwent mastectomy and was found to have pathologic complete response. We summarize possible explanations for residual calcifications, including benign and necrotic calcification processes, tumor shrinkage modes, and, most importantly, residual cancer.

Conclusion: Recent studies have shown poor correlation between residual mammographic microcalcifications and tumor burden visualized on MRI, as was also seen in our patient. In this case, surgical oncologists made the recommendation for mastectomy given the significant posttreatment increase in calcifications on mammogram despite treatment response seen on MRI. Studies have also demonstrated poor correlation between residual mammographic calcifications and pathologic complete response. Interestingly, Kim et al. [1] did not find any cases of pathologic complete response with increased calcifications on mammography after neoadjuvant chemotherapy, which was precisely our patient’s course. References 1. Kim YS, Chang JM, Moon HG, et al. Residual mammographic microcalci?cations and enhancing lesions on MRI after neoadjuvant systemic chemotherapy for locally advanced breast cancer: correlation with histopathologic residual tumor size. Ann Surg Oncol 2016; 23:1135–1142