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

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. 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. 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. 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.