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Response-Adapted Surgery for Residual Calcifications in HER2-Positive Breast Cancer After Neoadjuvant Chemotherapy
Jeong Eon Lee1, Cho Eun Lee1, Seok Jin Nam1
1Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Journal of Breast Cancer
|June 4, 2026
Summary
Residual microcalcifications after HER2-positive breast cancer treatment may not indicate disease. Selected patients can achieve excellent outcomes with response-adapted surgery, avoiding extensive excisions.
Area of Science:
- Oncology
- Radiology
- Breast Cancer Research
Background:
- The clinical significance of residual mammographic microcalcifications post-neoadjuvant therapy in HER2-positive breast cancer is uncertain.
- Traditionally, persistent calcifications suggest residual disease, leading to extensive surgical interventions like mastectomy.
- Emerging evidence indicates calcifications may represent treatment effects rather than active cancer, especially with dual HER2-directed therapies.
Purpose of the Study:
- To synthesize evidence on the biological basis and clinical implications of residual microcalcifications after neoadjuvant therapy in HER2-positive breast cancer.
- To evaluate the safety and efficacy of response-adapted surgical approaches in managing these calcifications.
- To emphasize recent findings from Korean studies and their impact on surgical decision-making.
Main Methods:
- Review and synthesis of emerging evidence, including recent Korean multicenter cohort studies.
- Analysis of radiologic response and pathologic complete response in relation to local control.
- Evaluation of a validated prediction model for treatment outcomes.
Main Results:
- Patients with favorable radiologic response and pathologic complete response show excellent local control after breast-conserving surgery, even with residual calcifications.
- A large multicenter study reported a 5-year local recurrence-free survival rate of 97.4%.
- A validated prediction model demonstrated strong discriminatory performance in assessing outcomes.
Conclusions:
- Current evidence supports a response-adapted surgical approach for selected HER2-positive breast cancer patients with residual calcifications.
- Clip-guided excision of the invasive lesion and whole-breast irradiation may be sufficient, avoiding removal of the entire calcification field.
- Prospective validation with long-term follow-up is needed to refine patient selection and confirm the safety of this strategy.
