Disappearing microcalcification after neoadjuvant chemotherapy—a case report

Adwani, Asha; Lowe, Susan; Ebbs, S. R.

doi:10.1053/ejso.1999.0748

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…One study reported that of 99 patients who underwent NACT, microcalcifications in MG were only observed for 10 of these patients, the number of particles increased in 2, remained stable in 3, decreased in 4, and disappeared in one patient [27]. Other studies reported that calcifications may persist, disappear or even increase in patients who respond to NACT [28]–[31].…”

Section: Discussionmentioning

confidence: 99%

The Role of Mammographic Calcification in the Neoadjuvant Therapy of Breast Cancer Imaging Evaluation

Chen

et al. 2014

PLoS ONE

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IntroductionInvestigate the patterns of mammographically detected calcifications before and after neoadjuvant chemotherapy (NACT) to determine their value for efficacy evaluation and surgical decision making.Methods187 patients with malignant mammographic calcifications were followed to record the appearances and changes in the calcifications and to analyze their responses to NACT.ResultsPatients with calcifications had higher rates of hormonal receptor (HR) positive tumors (74.3% versus 64.6%) and HER2 positive tumors (51.3% versus 33.4%, p = 0.004) and a similar pathologic complete response (pCR) rate compared to patients without calcifications (35.4% versus 29.8%). After NACT, the range of calcification decreased in 40% of patients, increased in 7.5% and remained stable in 52.5%; the calcification density decreased in 15% of patients, increased in 7.5% and remained stable in 77.5%; none of these change patterns were related to tumor response rate. No significant correlation was observed between the calcification appearance (morphology, distribution, range, diameter or density) and tumor subtypes or pCR rates. Among patients with malignant calcifications, 54 showed calcifications alone, 40 occurred with an architectural distortion (AD) and 93 with a mass. Calcifications were observed inside the tumor in 44% of patients and outside in 56%, with similar pCR rates and patterns of change.ConclusionsCalcification appearance did not clearly change after NACT, and calcification patterns were not related to pCR rate, suggesting that mammogram may not accurate to evaluate tumor response changes. Microcalcifications visible after NACT is essential for determining the extent of excision, patients with calcifications that occurred outside of the mass still had the opportunity for breast conservation.

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Section: Discussionmentioning

confidence: 99%

The Role of Mammographic Calcification in the Neoadjuvant Therapy of Breast Cancer Imaging Evaluation

Chen

et al. 2014

PLoS ONE

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“…In contrary, some studies have reported a decrease in the number of microcalcifications with neoadjuvant chemotherapy or even complete disappearance. Adwani et al [12] reported a case of complete resolution of all malignant-appearing microcalcifications after neoadjuvant chemotherapy, but Noguera Tajadura et al found that microcalcifications evolve unpredictably and independently of tumor response to neoadjuvant chemotherapy [17]. Moskovic et al [11] hypothesized that residual microcalcifications after neoadjuvant chemotherapy could be explained by the calcification of necrotic material remaining from the tumor or even fat necrosis or hematoma formation after biopsy.…”

Section: Discussionmentioning

confidence: 99%

Pathologic Complete Response of HER-2 Neu-Positive Invasive Ductal Carcinoma and Ductal CarcinomaIn Situfollowing Neoadjuvant Chemotherapy plus Trastuzumab: A Case Report and Review of Literature

Gunia

Patel

Mamounas

2012

Case Reports in Surgery

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Pathologic complete response (pCR) after NC has been consistently associated with improved outcomes. Residual DCIS after NC does not portray worse prognosis compared to complete eradication of all disease but has clinical implications regarding surgical management. We report a case of pCR of DCIS associated with invasive carcinoma in an HER-2 + tumor after NC plus trastuzumab despite persistence of malignant-appearing microcalcifications mammographically. A 41-year-old Caucasian female presented with a 4 × 4 cm mass in the right breast and a 2.5 cm right axillary node. Mammogram showed a 2.5 cm mass and a 12 cm area of linear pleomorphic, suspicious calcifications in the upper part of the breast. Core biopsy revealed invasive ductal carcinoma and DCIS associated with calcifications (ER 85%, PR 6%, Her2neu 3+ by IHC). Axillary node FNA was positive for malignancy. The patient received doxorubicin/cyclophosphamide (AC) → paclitaxel plus T with complete clinical and radiologic response but no significant change in the microcalcifications. Final pathology showed no residual invasive carcinoma or DCIS despite the presence of numerous ducts with microcalcifications. Documented eradication of DCIS has not been reported following NC when malignant-appearing calcifications persist and this observation may have important clinical implications regarding surgical management.

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“…In our opinion, due to the high incidence reported, laparoscopic cholecystectomy is contraindicated when gallbladder cancer is known or suspected preoperatively. If signs of malignancy are encountered during a laparoscopic cholecystectomy, the surgeon should convert to an open procedure [35, 36, 64]. …”

Section: Preventionmentioning

confidence: 99%

Tumor Cell Dissemination during Laparoscopy: Prevention and Therapeutic Opportunities

2002

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Port-site recurrences (PSRs) are abdominal wall recurrences that occur in the subcutaneous tissue within a trocar site after cancer laparoscopy and are not associated with peritoneal carcinomatosis. In order to develop PSRs, viable tumor cells must be liberated from the primary tumor, be transported to a wound, and find there a favorable environment for growth. The short clinical delay in the occurrence of PSRs and their size suggest massive cell seeding into the abdominal wall. Traumatic handling of the tumor, slipping of trocars, liquid projection, as well as poor extraction techniques can all cause implantation of malignant cells into the subcutaneous tissue. Such contact can also occur postoperatively if the trocar channels remain open. Some histologies (e.g. gallbladder adenocarcinoma), the presence of ascites and advanced tumor stage are risk factors for PSRs. Further conditions – including the use of gas – might also play a limited role. The first preventive measure is the correct indication for a laparoscopic approach. Several techniques have been demonstrated to prevent PSRs in the animal model: (a) fixation of trocars to the abdominal wall; (b) prevention of leakage; (c) careful specimen handling; (d) reducing trauma to the abdominal wall; (e) specimen isolation before extraction from the abdominal cavity; (f) trocar-site irrigation with a cytotoxic solution, and (g) closure of peritoneum. Further innovative therapies are currently under investigation. In the clinical setting, correct indication, surgical expertise and application of prophylactic measures seem to be the best way to prevent the occurrence of PSRs.

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Disappearing microcalcification after neoadjuvant chemotherapy—a case report

Cited by 13 publications

References 11 publications

The Role of Mammographic Calcification in the Neoadjuvant Therapy of Breast Cancer Imaging Evaluation

The Role of Mammographic Calcification in the Neoadjuvant Therapy of Breast Cancer Imaging Evaluation

Pathologic Complete Response of HER-2 Neu-Positive Invasive Ductal Carcinoma and Ductal CarcinomaIn Situfollowing Neoadjuvant Chemotherapy plus Trastuzumab: A Case Report and Review of Literature

Tumor Cell Dissemination during Laparoscopy: Prevention and Therapeutic Opportunities

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