Zhu Chao, Chen Minglei, Liu Yulin, Li Pinxiong, Ye Weitao, Ye Huifen, Ye Yunrui, Liu Zaiyi, Liang Changhong, Liu Chunling
Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
Quant Imaging Med Surg. 2023 Sep 1;13(9):5593-5604. doi: 10.21037/qims-22-1170. Epub 2023 Aug 11.
Microcalcifications persist even if a patient with breast cancer achieves pathologic complete response (pCR) as confirmed by surgery after neoadjuvant treatment (NAT). In practice, surgeons tend to remove all the microcalcifications. This study aimed to explore the correlation between changes in the extent of microcalcification after NAT and pathological tumor response and compare the accuracy of mammography (MG) and magnetic resonance imaging (MRI) in predicting the size of residual tumors.
This was a retrospective study which included a consecutive series of patients in Guangdong Provincial People's Hospital. Between January 2010 and January 2020, 127 patients with breast cancer and Breast Imaging Reporting and Data System (BI-RADS) 4-5 microcalcifications were included in this study. The maximum diameter of the microcalcifications on MG and lesion enhancement on MRI pre- and post-NAT were measured. The correlations between the changes in residual microcalcifications on MG and pCR were analyzed. Intraclass correlation coefficients (ICCs) were computed between the extent of the residual microcalcifications, residual enhancement, and residual tumor size.
There were no statistically significant differences in the changes in microcalcifications after NAT according to the RECIST criteria on MRI (P=0.09) and Miller-Payne grade (P=0.14). MRI showed a higher agreement than did residual microcalcifications on MG in predicting residual tumor size (ICC: 0.771 0.097).
MRI is more accurate for evaluating residual tumor size in breast cancer. In our study, the extent of microcalcifications on MG after NAT had nearly no correlation with the pathological size of the residual tumor. Therefore, residual tumors with microcalcifications may not necessarily be a contraindication to breast-conserving surgery.
即使乳腺癌患者在新辅助治疗（NAT）后经手术证实达到病理完全缓解（pCR），微钙化仍会持续存在。在实际操作中，外科医生倾向于切除所有微钙化灶。本研究旨在探讨NAT后微钙化范围变化与病理肿瘤反应之间的相关性，并比较乳腺钼靶（MG）和磁共振成像（MRI）在预测残留肿瘤大小方面的准确性。
这是一项回顾性研究，纳入了广东省人民医院的一系列连续患者。2010年1月至2020年1月期间，本研究纳入了127例患有乳腺癌且乳腺影像报告和数据系统（BI-RADS）4-5级微钙化的患者。测量了NAT前后MG上微钙化的最大直径以及MRI上病变的强化情况。分析了MG上残留微钙化变化与pCR之间的相关性。计算了残留微钙化范围、残留强化和残留肿瘤大小之间的组内相关系数（ICC）。
根据MRI上的RECIST标准（P=0.09）和Miller-Payne分级（P=0.14），NAT后微钙化的变化无统计学显著差异。在预测残留肿瘤大小方面，MRI显示出比MG上的残留微钙化更高的一致性（ICC：0.771±0.097）。
MRI在评估乳腺癌残留肿瘤大小方面更准确。在我们的研究中，NAT后MG上微钙化的范围与残留肿瘤的病理大小几乎没有相关性。因此，伴有微钙化的残留肿瘤不一定是保乳手术的禁忌证。
