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Calcifications Affect Pathologic Complete Response and MRI Prediction after Neoadjuvant Chemotherapy in Human Epidermal Growth Factor Receptor 2-positive Breast Cancer

  • 0Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
Radiology +

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September 9, 2025

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September 9, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Calcifications in HER2-positive breast cancer may lower the accuracy of predicting pathologic complete response (pCR) using MRI-detected radiologic complete response (rCR). Absence of calcifications is linked to better treatment response and more reliable imaging predictions.

Area Of Science

  • Oncology
  • Radiology
  • Breast Cancer Research

Background

  • Optimal surgical management for HER2-positive breast cancer with calcifications is debated, especially when pathologic complete response (pCR) is anticipated.
  • Predicting pCR using imaging before surgery is crucial for treatment planning in HER2-positive breast cancer.

Purpose Of The Study

  • To identify factors associated with pCR after neoadjuvant chemotherapy in HER2-positive breast cancer patients.
  • To evaluate the impact of calcifications on the accuracy of MRI-based radiologic complete response (rCR) in predicting pCR.

Main Methods

  • Retrospective analysis of 732 HER2-positive breast cancer patients treated with neoadjuvant chemotherapy and surgery.
  • Logistic regression used to analyze associations between clinicopathologic/imaging factors and pCR.
  • Comparison of MRI rCR diagnostic performance for pCR prediction in patients with and without calcifications.

Main Results

  • Factors associated with pCR included estrogen receptor-low subtype, hormone receptor-negative subtype, absence of calcifications, and rCR at MRI.
  • Patients with calcifications had lower pCR rates (37.1%) and lower positive predictive value (PPV) of rCR at MRI (60.0%) compared to those without calcifications (pCR 48.4%, PPV 73.1%).
  • Broadening the pCR definition to include ypT0/Tis eliminated the difference in pCR rates between patients with and without calcifications.

Conclusions

  • Absence of calcifications is associated with a higher pCR rate in HER2-positive breast cancer.
  • The presence of calcifications reduces the positive predictive value of MRI-detected rCR for predicting pCR.
  • Imaging-based prediction of treatment response in HER2-positive breast cancer is influenced by the presence of calcifications.