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Macroscopic handling and reporting of breast cancer specimens pre‐ and post‐neoadjuvant chemotherapy treatment: review of pathological issues and suggested approaches
Author(s) -
Pinder Sarah E,
Rakha Emad A,
Purdie Colin A,
Bartlett John M S,
Francis Adele,
Stein Robert C,
Thompson Alastair M,
Shaaban Abeer M
Publication year - 2015
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12649
Subject(s) - breast cancer , pathological , medicine , biopsy , oncology , neoadjuvant therapy , chemotherapy , cancer , pathology , biomarker , biology , biochemistry
Neoadjuvant chemotherapy ( NACT ) is used increasingly in the treatment of invasive breast cancer and presents challenges for the pathologist in the handling and interpretation of tissues. Potential issues include pathological identification and localization of the residual tumour site; how best to assess pathological response (given the diversity of scoring systems described); the timing and assessment of axillary node biopsy; and the value of retesting any residual tumour for dissonance between core biopsy and post‐treatment residual cancer cells for biomarker expression such as oestrogen and progesterone receptors and human epidermal growth factor receptor 2 ( HER 2). The role of the pathologist is critical in modern NACT approaches to breast cancer and is likely to remain challenging as novel agents and newer biomarkers become available. In this manuscript we review these issues and describe some practical approaches to handling and reporting these samples in the routine histopathology laboratory.