Early predictive value of calcification on ultrasound and mammography for pathological complete response to neoadjuvant chemotherapy in breast cancer.

OBJECTIVE: This study aimed to evaluate early predictors of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer and analyze tumor regression factors by integrating clinicopathological and imaging features. METHODS: We retrospectively analyzed the clinical data from 149 breast cancer patients who received neoadjuvant chemotherapy (NAC) at our hospital between January 2021 and January 2023, dividing them into pCR (61) and non-pCR (88) groups. Student’s t-test, chi-square test, multivariate logistic regression, and ROC curve analysis assessed pCR-associated factors and the predictive value of ultrasound-mammography combinations. RESULTS: Significant group differences (P < 0.05) emerged in imaging features (ultrasound/mammographic calcification characteristics) and clinicopathological markers (clinical stage, T3 status, HER2, Ki67, EGFR). Multivariate analysis identified independent pCR predictors: ultrasound-detected calcifications (OR = 0.07), mammographic grouped calcifications (OR = 0.12), T3 stage (OR = 0.02), and HER2 − /EGFR + status (OR = 0.14), all linked to lower pCR rates. Combined ultrasound-mammography calcification analysis showed a larger AUC (area under ROC curve) than single-modality assessments. CONCLUSIONS: Pretreatment ultrasound calcifications, mammographic grouped calcifications, advanced T stage, HER2 negativity, and EGFR positivity correlate with reduced pCR after NAC, indicating poorer prognosis. Ultrasound-mammography combination demonstrates high predictive value for pCR assessment, enhancing NAC response evaluation in breast cancer.