Association between mammographic features and response to neoadjuvant chemotherapy in locally advanced breast carcinoma

ABSTRACT

Mammography is the cornerstone of breast cancer [BC] evaluation. This report investigates whether breast density [BD] and mammographic features of the tumor can provide information on both BC susceptibility to chemotherapy and other clinicopathologic features of locally advanced BC [LA BC]. We evaluated mammography films and clinicopathological information of patients with LA BC who received neoadjuvant chemotherapy [NAC] followed by tumor resection at the Instituto Nacional de Enfermedades Neoplasicas [INEN] from 2000 to 2011. We selected 494 LA BC cases. Most cases were at clinical tumor stage 4 [48.5%], node stage 1 [58.8%] and had high histologic grade [53.3%]. BI-RADS 1, 2, 3, and 4 BD were found in 16.9%, 22%, 35.7% and 25.1% of patients, respectively. High BD has been associated with younger age [p<0.001], obesity [p = 0.017] and no skin infiltration [T3 vs T4] [p = 0.018]. An association between dusty microcalcifications and HER2 group, as well as between casting microcalcifications and TN BC group [p = 0.05] was found. NAC included anthracyclines and taxanes in 422 [85.5%] cases. Miller-Payne pathologic responses 4 and 5 [pCR] in the primary lesion and absence of axillary lymph nodes involvement were found in 15.3% of cases and were associated with younger age [p < 0.001] and HG-3 lesions [p < 0.001], but not with mammographic images. Mammographic features are associated with specific clinicopathological features of pre-NAC BC lesions but do not predict pCR. The implications and biological reasons for these findings require further study