Correlation Analysis Of Microcalcification Changes With Pathological Complete Response After Neoadjuvant Chemotherapy In Breast Cancer

ObjectiveIn this study,we analyzed the changes of microcalcification(MC)in patients with breast cancer after neoadjuvant chemotherapy(NAC)with clinicopathological characteristics,to investigate the correlation between microcalcifications and the rate of pathological complete response(p CR),and to further evaluate the accuracy of predicting p CR by microcalcification reduction in mammography(MG).Meanwhile,we correlated the distribution of microcalcifications with the molecular subtype of breast cancer,explored the correlation between the basic characteristics of microcalcifications and the molecular subtype of breast cancer,and further analyzed the correlation between the changes of microcalcifications after neoadjuvant chemotherapy and the molecular subtype conversion of breast cancer after neoadjuvant chemotherapy.MethodsWe retrospectively analyzed the cases of patients with breast cancer visiting Tianjin Medical University Cancer Institute and Hospital from January 1,2015 to December 31,2018.We collected the clinical characteristics,radiographical results and pathological data of patients before and after neoadjuvant chemotherapy whose microcalcification were confirmed by mammography.The patients should also be diagnosed with invasive breast cancer by hollow needle aspiration biopsy and receive surgery in our hospital.We applied Chi-square test to evaluate the relevant factors of neoadjuvant chemotherapy on the changes of microcalcification and investigate the correlation between changes of microcalcification and other clinical factors including p CR rate,molecular subtype of breast cancer and its conversion during chemotherapy.Receiver operating characteristic curve(ROC)was used to evaluate the accuracy of prediction of p CR by the reduction of microcalcification in mammography.Results215 cases met the inclusion criteria.After NAC,the MC range decreased in 91 cases,increased in 39 cases,and remained unchanged in 85 cases;the quantity of MC points decreased in 99 cases,increased in 56 cases,and remained unchanged in 60 cases.Patients were more likely achieving decrease of MC if she had dispersion distribution of microcalcification,or the initial range of microcalcifications was more than 2 cm,or the quantity of microcalcification points were more than 20.The difference was statistically significant.In this study,in the group of microcalcification range reduction and non-reduction,the p CR rate was higher in the group of microcalcification range reduction,the difference was statistically significant;there was no significant difference between the group of microcalcification quantity reduction and the control group.The AUC value and 95% confidence interval of microcalcification range reduction to predict the pathological complete response rate were 0.676 and 0.609-0.738 respectively(p < 0.0001).Furthermore,we found that there was no correlation between microcalcification morphology and molecular subtype of breast cancer.After neoadjuvant chemotherapy,there were 25 cases occurring changes in hormone receptor status,but these incidences had no correlation with the changes of microcalcification.The difference was not significant.ConclusionThe factors that affect the changes of microcalcifications in patients with breast cancer after neoadjuvant chemotherapy were the range,quantity and distribution of microcalcifications.Patients occurring reduction of microcalcifications range had a high rate of p CR,but the accuracy of predicting p CR based on the reduction of microcalcification range and quantity were still low.As a consequence,mammography is not recommended to evaluate tumor response after neoadjuvant chemotherapy.There was no correlation between the morphology of microcalcification and the molecular subtype of breast cancer.There was no significant difference between the changes of microcalcification and the changes of tumor hormone receptor level after neoadjuvant chemotherapy.It is not supportive that microcalcification can predict the molecular subtype of breast cancer and the changes of hormone receptor status.