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Kim EY, Lee KH, Yun JS, Park YL, Park CH, Jang SY, Ryu JM, Lee SK, Chae BJ, Lee JE, Kim SW, Nam SJ, Yu JH. Impact of residual microcalcifcations on prognosis after neoadjuvant chemotherapy in breast cancer patients. BMC Womens Health 2024; 24:187. [PMID: 38509531 PMCID: PMC10956337 DOI: 10.1186/s12905-024-02973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Residual microcalcifications after neoadjuvant chemotherapy (NAC) are challenging for deciding extent of surgery and questionable for impact on prognosis. We investigated changes in the extent and patterns of microcalcifications before and after NAC and correlated them with pathologic response. We also compared prognosis of patients depending on presence of residual microcalcifications after NAC. METHODS A total of 323 patients with invasive breast carcinoma treated with neoadjuvant chemotherapy at Kangbuk Samsung Hospital and Samsung Medical center from March 2015 to September 2018 were included. Patients were divided into four groups according to pathologic response and residual microcalcifications. Non-pCRw/mic group was defined as breast non-pCR with residual microcalcifications. Non-pCRw/o mic group was breast non-pCR without residual microcalcifications. pCRw/mic group was breast pCR with residual microcalcifications. pCRw/o mic group was breast pCR without residual microcalcifications. The first aim of this study is to investigate changes in the extent and patterns of microcalcifications before and after NAC and to correlate them with pathologic response. The second aim is to evaluate oncologic outcomes of residual microcalcifications according to pathologic response after NAC. RESULTS There were no statistical differences in the extent, morphology, and distribution of microcalcifications according to pathologic response and subtype after NAC (all p > 0.05). With a median follow-up time of 71 months, compared to pCRw/o mic group, the hazard ratios (95% confidence intervals) for regional recurrence were 5.190 (1.160-23.190) in non-pCRw/mic group and 5.970 (1.840-19.380) in non-pCRw/o mic group. Compared to pCRw/o mic group, the hazard ratios (95% CI) for distant metastasis were 8.520 (2.130-34.090) in non-pCRw/mic group, 9.120 (2.850-29.200) in non-pCRw/o mic group. Compared to pCRw/o mic, the hazard ratio (95% CI) for distant metastasis in pCRw/mic group was 2.240 (0.230-21.500) without statistical significance (p = 0.486). CONCLUSIONS Regardless of residual microcalcifications, patients who achieved pCR showed favorable long term outcome compared to non-pCR group.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwan Ho Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Jang
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Byung-Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jong Han Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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Tian Y, Zhao L, Gui Z, Liu S, Liu C, Yu T, Zhang L. PI3K/AKT signaling activates HIF1α to modulate the biological effects of invasive breast cancer with microcalcification. NPJ Breast Cancer 2023; 9:93. [PMID: 37957150 PMCID: PMC10643473 DOI: 10.1038/s41523-023-00598-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Microcalcification (MC) is a valuable diagnostic indicator of breast cancer, and it is reported to be associated with increased tumor aggressiveness and poor prognosis. Nevertheless, the exact potential molecular mechanism is not completely understood. Here, we find that the mineralized invasive breast cancer (IBC) cells not only increased their proliferation and migration, but also showed the characteristic of doxorubicin resistance. The PI3K/AKT signaling pathway is associated with the generation of calcification in IBC, and it activates the transcription and translation of its downstream hypoxia-inducible factor 1α (HIF1α). Knockdown of HIF1α protein significantly downregulated cell proliferation and migration while calcification persists. Meanwhile, calcified breast cancer cells restored sensitivity to doxorubicin because of suppressed HIF1α expression. In addition, we provide initial data on the underlying value of HIF1α as a biomarker of doxorubicin resistance. These findings provide a new direction for exploring microcalcifications in IBC.
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Affiliation(s)
- Yao Tian
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China
| | - Lu Zhao
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China
| | - Zhengwei Gui
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China
| | - Shiyang Liu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China
| | - Chenguang Liu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China
| | - Tianyao Yu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China
| | - Lin Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China.
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Savaridas SL, Vinnicombe SJ, Warwick V, Evans A. Predicting the response to neoadjuvant chemotherapy. Can the addition of tomosynthesis improve the accuracy of contrast-enhanced spectral mammography? A comparison with breast MRI. Br J Radiol 2023:20220921. [PMID: 37399083 PMCID: PMC10392651 DOI: 10.1259/bjr.20220921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES Image monitoring is essential to monitor response to neoadjuvant chemotherapy (NACT). Whilst breast MRI is the gold-standard technique, evidence suggests contrast-enhanced spectral mammography (CESM) is comparable. We investigate whether the addition of digital breast tomosynthesis (DBT) to CESM increases the accuracy of response prediction. METHODS Women receiving NACT for breast cancer were included. Imaging with CESM+DBT and MRI was performed post-NACT. Imaging appearance was compared with pathological specimens. Accuracy for predicting pathological complete response (pCR) and concordance with size of residual disease was calculated. RESULTS Sixteen cancers in 14 patients were included, 10 demonstrated pCR. Greatest accuracy for predicting pCR was with CESM enhancement (accuracy: 81.3%, sensitivity: 100%, specificity: 57.1%), followed by MRI (accuracy: 62.5%, sensitivity: 44.4%, specificity: 85.7%). Concordance with invasive tumour size was greater for CESM enhancement than MRI, concordance-coefficients 0.70 vs 0.66 respectively. MRI demonstrated greatest concordance with whole tumour size followed by CESM+microcalcification, concordance coefficients 0.86 vs 0.69. DBT did not improve accuracy for prediction of pCR or residual disease size. CESM+DBT underestimated size of residual disease, MRI overestimated but no significant differences were seen (p>0.05). CONCLUSIONS CESM is similar to MRI for predicting residual disease post-NACT. Size of enhancement alone demonstrates best concordance with invasive disease. Inclusion of residual microcalcification improves concordance with ductal carcinoma in situ. The addition of DBT to CESM does not improve accuracy. ADVANCES IN KNOWLEDGE The addition ofDBT to CESM does not improve NACT response prediction.CESM enhancement has greatest accuracy for residual invasive disease, CESM+calcification has greater accuracy for residual in situ disease.
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Affiliation(s)
- Sarah L Savaridas
- University of Dundee, Dundee, United Kingdom
- NHS Tayside, Dundee, United Kingdom
| | - Sarah J Vinnicombe
- Gloucestershire Hospitals, NHS Foundation Trust, Gloucester, United Kingdom
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Azam R, Lim D, Curpen B, Mulligan AM, Hong NL. Correlation of Mammographic Microcalcifications with Final Surgical Pathology After Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 2023:10.1245/s10434-023-13367-w. [PMID: 37029866 DOI: 10.1245/s10434-023-13367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/27/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Imaging guidelines for post-neoadjuvant chemotherapy (NAC) breast cancer patients lack specificity on appropriateness and utility of individual modalities for surgical planning. Microcalcifications confound mammographic interpretation. We examined the correlation between the mammographic extent of microcalcifications present post-NAC, corresponding magnetic resonance imaging (MRI) lesions, and definitive surgical pathology. METHODS In this retrospective cohort study, patients with calcifications on mammography were collected from a database of consecutive breast cancer patients receiving NAC. The primary objective was to determine the correlation between maximum dimension of post-NAC calcifications with surgical pathology (invasive disease, tumor bed, and ductal carcinoma in situ [DCIS]), stratified by tumor receptor subgroup. Secondarily, we examined the correlation of residual disease with MRI mass enhancement (ME) and non-ME (NME). Pearson's correlation coefficient was used to evaluate statistical significance (strong: R2 ≥70%; moderate: R2=25-70%; weak: R2 ≤25%). RESULTS Overall, 186 patients met the inclusion criteria. Mammographic calcifications correlated poorly with invasive disease (R2 = 10.8%), overestimating by 57%. In patients with calcifications on mammography, MRI ME and NME correlated weakly with the maximum dimension of invasive disease and DCIS. In triple-negative breast cancer (TNBC) patients, invasive disease correlated strongly with the maximum dimension of calcifications (R2 = 83%) and moderately with ME (R2 = 37.7%) and NME (R2 = 28.4%). CONCLUSION Overall, current imaging techniques correlate poorly and overestimate final surgical pathology. This poor correlation may lead to uncertainty in the extent of required surgical excision and the exclusion of potential candidates for non-surgical management in ongoing trials. TNBCs would be good candidates for these trials given the stronger observed correlations between pathology and imaging.
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Affiliation(s)
- Riordan Azam
- PGME University of Toronto, Toronto, ON, Canada.
| | - David Lim
- PGME University of Toronto, Toronto, ON, Canada
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Lee J, Park NJY, Park HY, Kim WW, Kang B, Keum H, Kim HJ, Kim WH, Chae YS, Lee SJ, Lee IH, Park JY, Jung JH. Oncologic necessity for the complete removal of residual microcalcifications after neoadjuvant chemotherapy for breast cancer. Sci Rep 2022; 12:21535. [PMID: 36513704 PMCID: PMC9748126 DOI: 10.1038/s41598-022-24757-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
The surgical range of breast cancer that shows pathologic complete response (pCR) without change in microcalcifications after neoadjuvant chemotherapy (NAC) is controversial. This study examined whole breast specimens to evaluate the necessity of mastectomy in those cases. The viability of cancer cells around the residual microcalcification was assessed using prospectively collected breast samples to confirm the presence or absence of cancer cells. A total of 144 patients with breast cancer and diffuse microcalcifications were classified into the reduced mass with no change in residual microcalcification (RESMIN, n = 49) and non-RESMIN (n = 95) groups. Five specimens were prospectively evaluated to assess the presence of viable cancer cells around the microcalcification. Tumor responses to NAC were significantly better with high pCR rates in the RESMIN group (p = 0.005 and p = 0.002). The incidence of human epidermal growth factor receptor 2-positive and triple-negative breast cancers was significantly high in the RESMIN group (p = 0.007). Although five (10.2%) patients had locoregional recurrence in the RESMIN group, no local recurrence in the breast was reported. Although pCR was highly estimated, residual cancers, including ductal carcinoma in situ, remained in 80% cases. Therefore, given the weak scientific evidence available currently, complete removal of residual microcalcifications should be considered for oncologic safety.
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Affiliation(s)
- Jeeyeon Lee
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Nora Jee-Young Park
- grid.258803.40000 0001 0661 1556Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ho Yong Park
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Wan Wook Kim
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Byeongju Kang
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Heejung Keum
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hye Jung Kim
- grid.258803.40000 0001 0661 1556Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Won Hwa Kim
- grid.258803.40000 0001 0661 1556Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Yee Soo Chae
- grid.258803.40000 0001 0661 1556Department of Hematology/Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Soo Jung Lee
- grid.258803.40000 0001 0661 1556Department of Hematology/Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - In Hee Lee
- grid.258803.40000 0001 0661 1556Department of Hematology/Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ji-Young Park
- grid.258803.40000 0001 0661 1556Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jin Hyang Jung
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Thompson BM, Chala LF, Shimizu C, Mano MS, Filassi JR, Geyer FC, Torres US, de Mello GGN, da Costa Leite C. Pre-treatment MRI tumor features and post-treatment mammographic findings: may they contribute to refining the prediction of pathologic complete response in post-neoadjuvant breast cancer patients with radiologic complete response on MRI? Eur Radiol 2021; 32:1663-1675. [PMID: 34716780 DOI: 10.1007/s00330-021-08290-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/05/2021] [Accepted: 08/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Radiologic complete response (rCR) in breast cancer patients after neoadjuvant chemotherapy (NAC) does not necessarily correlate with pathologic complete response (pCR), a marker traditionally associated with better outcomes. We sought to verify if data extracted from two important steps of the imaging workup (tumor features at pre-treatment MRI and post-treatment mammographic findings) might assist in refining the prediction of pCR in post-NAC patients showing rCR. METHODS A total of 115 post-NAC women with rCR on MRI (2010-2016) were retrospectively assessed. Pre-treatment MRI (lesion morphology, size, and distribution) and post-treatment mammographic findings (calcification, asymmetry, mass, architectural distortion) were assessed, as well as clinical and molecular variables. Bivariate and multivariate analyses evaluated correlation between such variables and pCR. Post-NAC mammographic findings and their correlation with ductal in situ carcinoma (DCIS) were evaluated using Pearson's correlation. RESULTS Tumor distribution at pre-treatment MRI was the only significant predictive imaging feature on multivariate analysis, with multicentric lesions having lower odds of pCR (p = 0.035). There was no significant association between tumor size and morphology with pCR. Mammographic residual calcifications were associated with DCIS (p = 0.009). The receptor subtype remained as a significant predictor, with HR-HER2 + and triple-negative status demonstrating higher odds of pCR on multivariate analyses. CONCLUSIONS Multicentric lesions on pre-NAC MRI were associated with a lower chance of pCR in post-NAC rCR patients. The receptor subtype remained a reliable predictor of pCR. Residual mammographic calcifications correlated with higher odds of malignancy, making the correlation between mammography and MRI essential for surgical planning. Key Points • The presence of a multicentric lesion on pre-NAC MRI, even though the patient reaches a radiologic complete response on MRI, is associated with a lower chance of pCR. • Molecular status of the tumor remained the only significant predictor of pathologic complete response in such patients in the present study. • Post-neoadjuvant residual calcifications found on mammography were related to higher odds of residual malignancy, making the correlation between mammography and MRI essential for surgical planning.
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Affiliation(s)
- Bruna M Thompson
- Institute of Radiology, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luciano F Chala
- Fleury Group, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
| | - Carlos Shimizu
- Institute of Radiology, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil.,Fleury Group, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil
| | - Max S Mano
- Department of Oncology, Hospital Sírio Libanês, São Paulo, Brazil
| | - José R Filassi
- Department of Gynecology and Obstetrics, Mastology Section, Instituto Do Câncer Do Estado de São Paulo, São Paulo, Brazil
| | - Felipe C Geyer
- Department of Pathology, Instituto Do Câncer Do Estado de São Paulo, São Paulo, Brazil
| | - Ulysses S Torres
- Fleury Group, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-010, Brazil.
| | | | - Cláudia da Costa Leite
- Institute of Radiology, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
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Lin YH, Yao W, Fei Q, Wang Y. Gastric cancer with calcifications: A case report. World J Clin Cases 2021; 9:8135-8141. [PMID: 34621872 PMCID: PMC8462209 DOI: 10.12998/wjcc.v9.i27.8135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mucinous gastric carcinoma (MGC) is a rare histological type of gastric carcinoma. Calcifications, seen on imaging and histopathological preparations, and which are infrequent in other types of gastric carcinoma, are characteristic of MGC. We present a patient with MGC with calcifications of the gastric wall and describe the computerized tomography (CT) features of the lesion and changes in the calcifications before and after chemotherapy.
CASE SUMMARY A 61-year-old man was admitted to our hospital in May 2020 because of a large, tender abdominal mass. Abdominal CT showed diffuse, irregular thickening of the gastric walls, with miliary and punctate calcifications. There were metastases to the perigastric and retroperitoneal lymph nodes and also peritoneal seeding. Histological examination of a specimen obtained by endoscopic biopsy showed poorly differentiated calcified signet-ring cell gastric cancer. The patient was clinically staged with T4N+M1 disease. He was treated with docetaxel, cisplatin, and fluorouracil as first-line therapy, irinotecan combined with S-1 as second-line chemotherapy, and programmed cell death protein 1 as third-line therapy. The patient underwent a total of nine cycles of chemotherapy. Follow-up CT scans every 3 mo showed continually increasing calcifications. As of this writing, the patient has survived almost 1 year.
CONCLUSION In this case report, we describe the histopathological and imaging characteristics of a patient with gastric cancer receiving chemotherapy. Multiple punctate calcifications were seen, which gradually increased during chemotherapy. Several possible mechanisms for the calcifications are described, but further research is needed. Future findings may lead to new approaches for the evaluation and treatment of such tumors.
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Affiliation(s)
- Yu-He Lin
- Department of Oncology, China Medical University Affiliated Shengjing Hospital, Shenyang 110022, Liaoning Province, China
| | - Wei Yao
- Department of Surgery, China Medical University Affiliated Shengjing Hospital, Shenyang 110000, Liaoning Province, China
| | - Qian Fei
- Department of Oncology, China Medical University Affiliated Shengjing Hospital, Shenyang 110022, Liaoning Province, China
| | - Ying Wang
- Department of Oncology, China Medical University Affiliated Shengjing Hospital, Shenyang 110022, Liaoning Province, China
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Iotti V, Ragazzi M, Besutti G, Marchesi V, Ravaioli S, Falco G, Coiro S, Bisagni A, Gasparini E, Giorgi Rossi P, Vacondio R, Pattacini P. Accuracy and Reproducibility of Contrast-Enhanced Mammography in the Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Patients with Calcifications in the Tumor Bed. Diagnostics (Basel) 2021; 11:diagnostics11030435. [PMID: 33806306 PMCID: PMC7999407 DOI: 10.3390/diagnostics11030435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022] Open
Abstract
This study aimed to evaluate contrast-enhanced mammography (CEM) accuracy and reproducibility in the detection and measurement of residual tumor after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients with calcifications, using surgical specimen pathology as the reference. Pre- and post-NAC CEM images of 36 consecutive BC patients receiving NAC in 2012–2020, with calcifications in the tumor bed at diagnosis, were retrospectively reviewed by two radiologists; described were absence/presence and size of residual disease based on contrast enhancement (CE) only and CE plus calcifications. Twenty-eight patients (77.8%) had invasive and 5 (13.9%) in situ-only residual disease at surgical specimen pathology. Considering CE plus calcifications instead of CE only, CEM sensitivity for invasive residual tumor increased from 85.7% (95% CI = 67.3–96%) to 96.4% (95% CI = 81.7–99.9%) and specificity decreased from 5/8 (62.5%; 95% CI = 24.5–91.5%) to 1/8 (14.3%; 95% CI = 0.4–57.9%). For in situ-only residual disease, false negatives decreased from 3 to 0 and false positives increased from 1 to 2. CEM pathology concordance in residual disease measurement increased (R squared from 0.38 to 0.45); inter-reader concordance decreased (R squared from 0.79 to 0.66). Considering CE plus calcifications to evaluate NAC response in BC patients increases sensitivity in detection and accuracy in measurement of residual disease but increases false positives.
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Affiliation(s)
- Valentina Iotti
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Moira Ragazzi
- Pathology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.R.); (A.B.)
| | - Giulia Besutti
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-0522-296369
| | - Vanessa Marchesi
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Sara Ravaioli
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Giuseppe Falco
- Breast Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.F.); (S.C.)
| | - Saverio Coiro
- Breast Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.F.); (S.C.)
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.R.); (A.B.)
| | - Elisa Gasparini
- Oncology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Rita Vacondio
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
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