Evaluating the Feasibility of Breast-Conserving Surgery in Breast Cancer Patients with Suspicious Calcifications After Neoadjuvant Chemotherapy: A Retrospective Cohort Study.

BACKGROUND

Suspicious calcifications in breast cancer (BC) often limit eligibility for breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC). This study assessed the impact of ductal carcinoma in situ (DCIS) status and post-NAC imaging changes on pathological complete response (pCR), BCS feasibility, and prognosis.

METHODS

We retrospectively analyzed 163 BC patients with suspicious calcifications treated with NAC (median follow-up, 38.9 months). Logistic regression identified predictors of pCR, associations between calcification changes and pCR were assessed using Cramer's V, and OS and DFS were evaluated using Kaplan-Meier analysis.

RESULTS

73 patients had DCIS and 90 had non-DCIS. Calcification reduction after NAC was more frequent in non-DCIS group (56.7%; p = 0.012). pCR rates were higher in non-DCIS group than in DCIS group (73.7% vs 26.3%; p = 0.015). After adjustment, DCIS was associated with reduced pCR rates (OR: 0.26, 95% CI: 0.08-0.73). Overall BCS rate was 11%. Calcification reduction showed a weak correlation with pCR (Cramer's V = 0.321). No significant OS, DFS, or BCS differences were observed by DCIS status or calcification change within follow-up.

CONCLUSION

DCIS is associated with reduced pCR after NAC. Calcification findings alone should be interpreted cautiously, and BCS feasibility should be assessed using comprehensive surgical criteria.