目前的手术政策建议对经过新辅助化疗（NAC）的乳腺癌患者进行全面切除肿瘤钙化物，而不考虑磁共振成像（MRI）结果，尽管MRI定义肿瘤反应优于乳腺X线摄影。本研究检测MRI预测具有和不具有钙化的肿瘤的反应，使用术后NAC病理作为参考标准。回顾分析2011年至2018年间的114名NAC患者，包括人口统计学、乳腺X线摄影、3T-MRI和病理，比较了两个亚组：没有（n = 62）或有（n = 52）乳腺X线摄影钙化。在钙化组中，乳腺X线摄影钙化的程度和MRI增强区域重叠。MRI预测NAC反应与病理相关。采用双尾T检验和Fisher精确检验以及Cohen's Kappa系数进行分析。 关于人口统计学，这两个亚组没有显着差异。肿瘤的大小、淋巴结受累和DCIS成分方面的特征相同。ER阴性/HER2阳性的肿瘤更常见出现钙化（33％n = 17钙化VS13％n = 8非钙化；P <0.05）；三阴性病理很少发生钙化（6％n = 3钙化发生VS33％n = 20非钙化发生；P <0.05）。出现钙化的同时NME 更普遍（62％n = 32钙化VS29％n = 18非钙化；P <0.05），而没有钙化的肿块的增强率为90％（n = 56非钙化VS81％n = 42钙化；P <0.05）。两组对NAC的反应相似（pCR = 37％非钙化VS 38％钙化），MRI上反应与病理的相关性相同（两个亚组均为69％；P = 0.988）。我们建议在规划术后NAC手术时利用术后MRI结果而不是乳腺X线摄影，因为MRI的预测独立于钙化的存在或缺失。有必要进行前瞻性研究来评估这种方法。• 在新辅助化疗之前乳腺X线摄影中没有或有肿瘤钙化物的患者之间没有人口统计学、临床、病理或成像特征的差异。• 残留的乳腺X线摄影钙化不足以预测残余的浸润性疾病。MRI准确识别完全反应，并在69％的患者中正确地与治疗后的手术病理相关，无论乳腺X线摄影是否存在钙化。• 我们建议在规划新辅助化疗后手术时利用术后MRI结果而不是乳腺X线摄影，因为MRI预测反应是独立于钙化的存在或缺失的。 ©2023。作者（们）独家许可欧洲放射学会。

Current surgical policy recommends comprehensive excision of tumorous calcifications in breast cancer patients following neoadjuvant chemotherapy (NAC) regardless of MRI outcomes, despite MRI defining tumor response superior to mammography. The current study examines MRI prediction of response in tumors with vs without calcifications, using post-NAC surgical pathology as the standard of reference.Retrospective analysis of 114 NAC patients between 2011 and 2018 including demographics, mammography, 3 T-MRI, and pathology compared two sub-groups: without (n = 62) or with (n = 52) mammographic calcifications. In the calcification cohort, the mammographic extent of calcifications and MRI enhancement overlapped. MRI prediction of response to NAC was correlated with pathology. Two-tailed paired T and Fisher's exact tests and Cohen's kappa coefficient were applied for analysis.There was no significant difference between the two sub-groups regarding demographics. Tumors demonstrated equivalent features regarding size, lymph node involvement, and DCIS component. ER-negative/HER2-positive tumors more commonly exhibited calcifications (33% n = 17 calcified vs 13% n = 8 non-calcified; p < 0.05); triple negative pathology rarely calcified (6% n = 3 calcified vs 33% n = 20 non-calcified; p < 0.05). NME was more common with calcifications (62% n = 32 calcified vs 29% n = 18 non-calcified; p < 0.05) and mass enhancement without (90% n = 56 non-calcified vs 81% n = 42 calcified; p < 0.05). Both groups responded similarly to NAC (pCR = 37% non-calcified vs 38% calcified); response on MRI equally correlated with pathology (69% both subgroups; p = 0.988).We propose utilizing post-NAC MRI findings rather than mammography in planning surgery, as MRI prediction is independent of the presence or absence of calcifications. Prospective studies to evaluate this approach are warranted.• No difference was found in demographic, clinical, pathology, or imaging characteristics between patients with or without tumoral calcifications on mammography prior to neoadjuvant chemotherapy. • Residual mammographic calcifications are inadequate predictors of residual invasive disease. MRI accurately recognized complete response and correctly correlated with post-treatment surgical pathology in 69% of patients, regardless of the presence or absence of mammographic calcifications. • We propose utilizing post-NAC MRI findings rather than mammography in planning post-NAC surgery, as MRI prediction of response is independent of the presence or absence of calcifications.© 2023. The Author(s), under exclusive licence to European Society of Radiology.