Pathologic reporting practices for breast cancer specimens after neoadjuvant chemotherapy—a survey of pathologists in academic institutions across the United States

Lanjewar, Sonali; Patil, Priyanka; Fineberg, Susan

doi:10.1038/s41379-019-0326-5

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…The RCB has been highlighted among the classi cation systems proposed [23,24]. Nevertheless, evaluation and reporting of post-NACT cases is a complex task and even experts in breast pathology disclose variability in this subject [25,26]. Our data corroborate cellularity as an independent prognostic factor in residual tumor of post-NACT cases and supports its inclusion in pathology reports.…”

Section: Discussionsupporting

confidence: 72%

Pathological response of breast cancer of patients treated by neoadjuvant chemotherapy and correlation with survival. A perspective of real-world pathology

Brito

Marques

et al. 2022

Preprint

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The main objective of this study is to evaluate the correlation of pathological parameters related to NACT and subsequent outcomes. The secondary objective is to correlate classical parameters and survival. We analyzed a retrospective cohort of 142 female patients treated with NACT, with primary breast cancer diagnosed between January 2011 and December 2017. Slides were reviewed by two independent pathologists. Treatment-related parameters were the average percentage of tumor cellularity, size of largest axillary metastasis, and regression pattern in lymph nodes. For statistical analysis, Kaplan–Meier method was applied to estimate the survival probability of the sample and overall survival (OS) and cancer-specific survival (SS). The Gehan-Breslow test was applied to evaluate the hypothesis of no difference in survival curves for different groups. In univariate regression analysis of parameters related to the treatment effect, macroscopic pattern, median of cellularity, cellularity pooled in 3 groups, and median of largest lymph node metastasis had independent prognostic values for overall survival (OS) and cancer-specific survival (SS). Classical parameters such as nuclear and histologic grade, mitotic index, grouped ypTNM stage, and lymphovascular invasion were also correlated to survival. In multivariate regression analysis, cellularity group ≥ 40% had a higher chance of death compared to 0–5% cellularity group for both OS (Hazard Ratio: 6.59; 95% Confidence Interval = 2.30–18.9; p < 0.001; adjusted Hazard Ratio: 3.40; 95% Confidence Interval = 1.12, 10.4; p = 0.031). and SS (Hazard Ratio: 3.9; 95% Confidence Interval = 1.58–9.72; p = 0.003; adjusted Hazard Ratio: 4.21; 95% Confidence Interval = 1.69–10.5; p = 0.002). Also, macroscopic pattern correlated to survival in multivariate analysis. The ypN1 + 2 + 3 stage group was the classical parameter with strongest correlation to worse prognosis for both OS (Hazard Ratio: 10.5; 95% Confidence Interval = 2.45–44.6; p = 0.002; adjusted Hazard Ratio: 6.78; 95% Confidence Interval = 1.50–30.6; p = 0.013) and SS (Hazard Ratio: 3.56; 95% Confidence Interval = 1.51–8.38; p = 0.004; adjusted Hazard Ratio: 2.65; 95% Confidence Interval = 1.09–6.48; p = 0.032). Other classical parameters such as triple-negative molecular subtype, lymphovascular invasion and nuclear grade 3 correlated to worse survival. Our findings support the incorporation of the percentage of tumor cellularity in the pathological reports of surgical specimens as an independent prognostic factor for patients treated with NACT.

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Section: Discussionsupporting

confidence: 72%

Pathological response of breast cancer of patients treated by neoadjuvant chemotherapy and correlation with survival. A perspective of real-world pathology

Brito

Marques

et al. 2022

Preprint

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“…There is no unanimous consensus and uniform practice regarding biomarkers retesting on residual tumour after NAT. 34 Reassessment is recommended in pretreatment triple-negative carcinoma. 11,35 The conversion to hormone receptor– and/or HER2-positive status in this tumour subtype can affect adjuvant therapy decision (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…switch to targeted therapy) and has been associated with improved survival. 34,36,37 Moreover, changes in the expression of PgR and Ki-67 after NAT have been shown to provide no predictive but prognostic information that may aid in recurrence risk stratification. 19,29 Although it may not be necessary for triple-positive tumours, reassessment of these biological characteristics after NAT can be useful to better understand the evolution of the disease, whether and how the tumour responds to the therapies, and consequently, to guide adjuvant therapy decision-making (Box 4).…”

Section: Methodsmentioning

confidence: 99%

Role and evaluation of pathologic response in early breast cancer specimens after neoadjuvant therapy: consensus statement

Guerini-Rocco

Botti

Foschini

et al. 2021

Tumori

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Pathologic evaluation of early breast cancer after neoadjuvant therapy is essential to provide prognostic information based on tumor response to treatment (pathologic complete response [pCR] or non-pCR) and to inform therapy decisions after surgery. To harmonize the pathologist’s handling of surgical specimens after neoadjuvant therapy, a panel of experts in breast cancer convened to developed a consensus on six main topics: (1) definition of pCR, (2) required clinical information, (3) gross examination and sampling, (4) microscopic examination, (5) evaluation of lymph node status, and (6) staging of residual breast tumor. The resulting consensus statements reported in this document highlight the role of an accurate evaluation of tumor response and define the minimum requirements to standardize the assessment of breast cancer specimens after neoadjuvant therapy.

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“…Most commonly, post-NAC tumors present with a lower grade due to a decrease in mitotic activity, but a subset may demonstrate a higher grade due to increased nuclear pleomorphism [ 59 ]. Recent publications have demonstrated that post-NAC grade and proliferation activity after therapy evaluated by the mitotic rate component of the Nottingham histologic grade are prognostic and should be reported [ 61 ].…”

Section: Pathological Evaluation Of Residual Diseasementioning

confidence: 99%

“…In addition to the ypTNM for pathologic quantification of residual disease after NAC, the AJCC recommends to evaluate the Residual Cancer Burden (RCB) that refers to the degree of residual disease after NAC [ 61 ]. RCB is associated with survival outcomes, especially in more aggressive BC subtypes, namely TNBC and HER2+ [ 62 ].…”

Section: Pathological Evaluation Of Residual Diseasementioning

confidence: 99%

Post-Neoadjuvant Treatment Strategies for Patients with Early Breast Cancer

Agostinetto

Jacobs

Debien

et al. 2022

Cancers

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Pre-surgical treatments in patients with early breast cancer allows a direct estimation of treatment efficacy, by comparing the tumor and the treatment. Patients who achieve a pathological complete response at surgery have a better prognosis, with lower risk of disease recurrence and death. Hence, clinical research efforts have been focusing on high-risk patients with residual disease at surgery, who may be “salvaged” through additional treatments administered in the post-neoadjuvant setting. In the present review, we aim to illustrate the development and advantages of the post-neoadjuvant setting, and to discuss the available strategies for patients with early breast cancer, either approved or under investigation. This review was written after literature search on main scientific databases (e.g., PubMed) and conference proceedings from major oncology conferences up to 1 August 2022. T-DM1 and capecitabine are currently approved as post-neoadjuvant treatments for patients with HER2-positive and triple-negative breast cancer, respectively, with residual disease at surgery. More recently, other treatment strategies have been approved for patients with high-risk early breast cancer, including the immune checkpoint inhibitor pembrolizumab, the PARP inhibitor olaparib and the CDK 4/6 inhibitor abemaciclib. Novel agents and treatment combinations are currently under investigation as promising post-neoadjuvant treatment strategies.

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Pathologic reporting practices for breast cancer specimens after neoadjuvant chemotherapy—a survey of pathologists in academic institutions across the United States

Cited by 9 publications

References 29 publications

Pathological response of breast cancer of patients treated by neoadjuvant chemotherapy and correlation with survival. A perspective of real-world pathology

Pathological response of breast cancer of patients treated by neoadjuvant chemotherapy and correlation with survival. A perspective of real-world pathology

Role and evaluation of pathologic response in early breast cancer specimens after neoadjuvant therapy: consensus statement

Post-Neoadjuvant Treatment Strategies for Patients with Early Breast Cancer

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