Residual Microcalcifications After Neoadjuvant Chemotherapy: Implications for Surgical Decision-Making-A Systematic...

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• The significance of residual microcalcifications post-neoadjuvant chemotherapy (NAC) in breast cancer is unclear.
• Traditionally, these are seen as indicators of malignancy, but many may be benign or in situ changes.
• This review clarifies the implications of persistent calcifications after NAC.

Purpose of the Study:

• To systematically review the diagnostic, pathologic, and oncologic implications of residual calcifications after NAC in breast cancer.
• To evaluate the prognostic relevance of these calcifications.
• To inform surgical planning for breast cancer patients treated with NAC.

Main Methods:

• Systematic literature search following PRISMA 2020 guidelines across major databases (PubMed, Embase, etc.) from January 2000 to May 2025.
• Included studies focused on adult breast cancer patients receiving NAC with residual calcifications and available histopathologic or survival data.
• Data extraction and quality assessment were performed independently by two reviewers.

Main Results:

• Twenty-four studies with over 3000 patients were analyzed.
• 35-55% of residual calcifications were benign; others were ductal carcinoma in situ, not invasive cancer.
• Persistent calcifications after pathologic complete response (pCR) did not consistently worsen survival and led to overtreatment in some cases.

Conclusions:

• Residual calcifications post-NAC are not definitive indicators of residual invasive disease or mandatory reasons for complete surgical excision.
• Their frequent benign/in situ nature and limited prognostic value support individualized surgical planning.
• Prioritize pathologic response and margin status over radiographic calcifications alone for surgical decisions.