评估术前残余乳腺钙化在新辅助化疗（NAC）后残余肿瘤预测中的价值。

回顾性研究2020年1月至2024年12月接受NAC并在乳腺X线摄影中显示肿瘤床内或附近可疑微钙化的乳腺癌患者。通过磁共振成像（MRI）对残余微钙化和残余病灶进行分析，并与残余肿瘤的组织病理学结果及免疫组化标志物进行相关性研究。使用SPSS 28.0统计学软件分析数据，采用Fisher检验、Pearson卡方检验及组内相关系数（ICC）评估。P<0.05被认为具有统计学意义。

共纳入96名患者，其中10名患者达到了病理完全缓解（pCR），可疑微钙化在10.4%（10/96）的患者中与良性病理相关。在其余86名未达到pCR的患者中，61.5%（59/96）的残余微钙化与侵袭性或原位癌相关，28.1%（27/96）与良性病理相关。与激素受体阴性（HR−）患者相比，激素受体阳性（HR+）患者的残余恶性微钙化比例最高（分别为48.9% vs. 13.5%；P=0.019）。MRI在预测所有亚型的残余肿瘤范围方面优于乳腺X线摄影中的残余微钙化（ICC=0.709 vs. 0.365）。对于HR/HER2+和HR/HER2-亚型，MRI与残余肿瘤大小的相关性更高（ICC分别为0.925、0.876）。

在NAC后，乳腺X线摄影中微钙化的程度与38.5%的女性残余癌症的程度无相关性。无论微钙化的程度如何，微钙化、化疗后MRI上的残余肿瘤范围以及分子亚型可能成为评估化疗后残余癌症的准确工具。

To evaluate the value of preoperative residual breast calcifications in predicting residual tumor after neoadjuvant chemotherapy (NAC).

A retrospective study was conducted on breast cancer patients who received NAC from January 2020 to December 2024 and showed suspicious microcalcifications within or near the tumor bed on mammography. Residual microcalcifications and residual lesions were analyzed by magnetic resonance imaging (MRI), and correlated with histopathological findings of residual tumors and immunohistochemical markers. Statistical analysis was performed using SPSS 28.0, with Fisher's exact test, Pearson's chi-square test, and intraclass correlation coefficient (ICC). P<0.05 was considered statistically significant.

A total of 96 patients were enrolled, including 10 who achieved pathological complete response (pCR). Suspicious microcalcifications were associated with benign pathology in 10.4% (10/96) of patients. Among the remaining 86 patients without pCR, residual microcalcifications were associated with invasive or in-situ carcinoma in 61.5% (59/96) and with benign pathology in 28.1% (27/96). The proportion of residual malignant microcalcifications was highest in hormone receptor-positive (HR+) patients compared with HR-negative (HR-) patients (48.9% vs. 13.5%, respectively; P=0.019). MRI was superior to residual microcalcifications on mammography in predicting residual tumor extent across all subtypes (ICC=0.709 vs. 0.365). MRI showed higher correlation with residual tumor size for HR/HER2+ and HR/HER2- subtypes (ICC=0.925 and 0.876, respectively).

After NAC, the extent of microcalcifications on mammography does not correlate with the extent of residual cancer in 38.5% of women. Regardless of the extent of microcalcifications, microcalcifications, residual tumor extent on post-chemotherapy MRI, and molecular subtype may serve as accurate tools for evaluating post-chemotherapy residual cancer.