J Pathol Transl Med.  2016 May;50(3):173-180. 10.4132/jptm.2016.02.02.

Pathologic Evaluation of Breast Cancer after Neoadjuvant Therapy

• Park CK
• Jung WH
• Koo JS

• KMID: 2164593
• DOI: http://doi.org/10.4132/jptm.2016.02.02

Abstract

Breast cancer, one of the most common cancers in women, has various treatment modalities. Neoadjuvant therapy (NAT) has been used in many clinical trials because it is easy to evaluate the treatment response to therapeutic agents in a short time period; consequently, NAT is currently a standard treatment modality for large-sized and locally advanced breast cancers, and its use in early-stage breast cancer is becoming more common. Thus, chances to encounter breast tissue from patients treated with NAT is increasing. However, systems for handling and evaluating such specimens have not been established. Several evaluation systems emphasize a multidisciplinary approach to increase the accuracy of breast cancer assessment. Thus, detailed and systematic evaluation of clinical, radiologic, and pathologic findings is important. In this review, we compare the major problems of each evaluation system and discuss important points for handling and evaluating NAT-treated breast specimens.

Keyword

Breast neoplasms; Neoadjuvant therapy; Pathologic response evaluation

MeSH Terms

Breast Neoplasms*
Breast*
Female
Humans
Neoadjuvant Therapy*

Figure

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  Fig. 1. Differences in tumor evaluation results according to tissue sampling method in breast cancer after neoadjuvant therapy. In this example, when sampling in the area indicated by the blue rectangle, aspects of the residual tumor (e.g., tumor size/extent) are observed and appear different from the sampling area indicated by the purple rectangle, where heterogeneity of the residual tumor and tumor bed is present.

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  Fig. 2. Comparison of tumor size/extent measurements between the Residual Cancer Burden (RCB) and ypTNM systems. In the RCB system, the largest cross-section among areas with invasive tumors is measured in two dimensions (a). In the ypTNM system, the largest contiguous invasive carcinoma foci are measured (b).

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  Fig. 3. Comparison of tumor cellularity between pre-neoadjuvant therapy (NAT) and post-NAT. In comparison with the tumor cellularity of a pre-NAT biopsy (A), the tumor cellularity observed in a post-NAT surgical specimen (B) is significantly low.

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  Fig. 4. Residual tumor emboli in lymphovascular space after neoadjuvant therapy (NAT) (A, B). There are only tumor emboli in the lymphovascular space after NAT.

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  Fig. 5. Metastatic residual carcinoma in a lymph node with histologic features indicative of tumor regression: in low-power view, an axillary lymph node shows lymphocyte depletion, fibrosis, and aggregation of foamy histiocytes (green circle, A), which we suggest are histologic features indicative of tumor regression due to neoadjuvant therapy. In high-power view, metastatic tumor cell clusters are identified in a regressed lymph node (arrows, B). Immunohistochemistry for cytokeratin is helpful to identify metastatic tumor cell clusters in a regressed lymph node (C, D).

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