Pathological Controversies in Breast Cancer: Classification of Ductal Carcinoma In Situ,Sentinel Lymph Nodes and Low Volume Metastatic Disease and Reporting of Neoadjuvant Chemotherapy Specimens |
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| Authors: | E. Provenzano J.P. Brown S.E. Pinder |
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| Affiliation: | 1. Department of Pathology, University of Melbourne, Parkville, Victoria, Australia;2. Focus Pathology, South Yarra, Victoria, Australia;3. Breast Pathology Research, Research Oncology, Division of Cancer Studies, Kings College London, London, UK;1. Department of Radiology, Beth Israel Medical Center, 16th Street and 1st Avenue, New York, NY 10003, USA;2. Department of Radiology, University of Washington, 325 9th Avenue, Seattle, WA 98104-2499, USA;3. Mayo Clinic LL Radiology, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA;1. University of Colorado Cancer Center, 12801 E 17th Avenue, Aurora, CO 80045, USA;2. University of California Davis Comprehensive Cancer Centre, Sacramento, CA, USA;1. Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan;2. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan;1. Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar, Italy;1. Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio;2. Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio;3. Department of Otolaryngology – Head and Neck Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio;1. Department of Pathology, Jersey Shore Medical Center, Neptune, New Jersey;2. Department of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy;3. Department of Pathology, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, Maryland;4. Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland |
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| Abstract: | The pathological classification of breast cancer is constantly being updated to reflect the advances in our clinical and biological understanding of the disease. This overview examines new insights into the classification and molecular biology of ductal carcinoma in situ, the pathological handling of sentinel lymph node biopsies and the identification of low volume disease (micrometastases and isolated tumour cells) and the handling and reporting of specimens after neoadjuvant therapy. The molecular subtypes of invasive breast cancer are also represented in ductal carcinoma in situ. It is hoped that alongside traditional histological features, such as cytological grade and the presence of necrosis, this will lead to better classification systems with improved prediction of clinical behaviour, in particular the risk of progression to invasive cancer, and enable more targeted management. Sentinel lymph node biopsy is now the standard of care for early stage breast cancer in clinically node-negative patients. However, the handling and reporting of these specimens remains controversial, largely related to the uncertainties regarding the clinical significance of micrometastases and isolated tumour cells. The increasing use of neoadjuvant therapies has introduced challenges for the pathologist in the handling and interpretation of these specimens. Grading the tumour response, particularly the identification of a complete pathological response, is prognostically important. However, there is still marked variability in reporting these specimens in routine practice, and consensus guidelines for the histopathology reporting of breast cancers after neoadjuvant chemotherapy based on robust, validated evidence are presently lacking. |
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