Primary breast cancer: Mammographic changes after neoadjuvant chemotherapy, with pathologic correlation

PURPOSE: To correlate changes depicted at mammography during neoadjuvant chemotherapy for operable breast carcinoma with subsequent pathologic status. MATERIALS AND METHODS: Patients (n = 107) underwent mammography before and after neoadjuvant chemotherapy, prior to surgery. Four retrospectively determined grades of response at mammography included complete, mammographic (decreased size and/or density), stable disease, or progressive disease. RESULTS: In 95 fully assessable patients, grade of response to chemotherapy was complete in eight (9%), mammographic in 78 (82%), stable disease in seven (7%), and progressive disease in two (2%). Before and after treatment, respectively, 64 (67%) and 20 (21%) masses were greater than 2 cm in bidimensional diameter. Response was not complete in any of the 44 (46%) cases of microcalcifications. At histologic examination after surgery in 95 fully assessable patients, five of eight patients with complete response were found to have residual tumor (three with an invasive component); eight were found to have no residual tumor (response in three was complete; in four, mammographic; and in one, stable disease). CONCLUSION: Whereas mammograms in most patients showed some response to chemotherapy, prediction of pathologic outcome was not possible.