Evaluation of Breast Cancer After Neoadjuvant Therapy

Neoadjuvant therapy is an important treatment option in an increasing number of patients with breast cancer. Accurate initial histopathologic diagnosis and biomarker assessment of breast cancers are critical in the identification and treatment of appropriate candidates for presurgical systemic therapy. Precise assessment and reporting of post-treatment breast specimens are essential to provide the most relevant information for the multidisciplinary treatment team to care for these patients. This presentation will review the clinical indications for neoadjuvant therapy and the role of the pathologist in this treatment pathway. How the Residual Cancer Burden (RCB) and AJCC Classification systems compare when used in the reporting of post-treatment breast specimens will be addressed.

Lecture Presenter
Susan C. Lester, MD, PhD
Susan C. Lester, MD, PhD
Senior Consultant, Brigham and Women's Hospital, Department of Pathology and Dana Farber Cancer Institute
Assistant Professor of Pathology, Harvard Medical School

Dr. Lester received her PhD in genetics at the University of Wisconsin and her MD from Harvard Medical School. She trained in pathology at Brigham and Women’s Hospital in Boston and was the Chief of Breast Pathology Services for over 20 years. She has served on committees for the College of American Pathology, the American Joint Committee on Cancer, and the World Health Organization. She was the chairperson of the CAP breast cancer review panel during the development of the first standardized reporting protocol for DCIS as well as a major revision of the invasive cancer protocol. Dr. Lester is well known for writing the Manual of Surgical Pathology, as well as co-writing Diagnostic Pathology: Breast with Dr. David Hicks, and being the lead writer of Diagnostic Pathology: Intraoperative Consultation (both included in ExpertPath and PathPrimer). She has also written numerous chapters including the Breast Chapter for Robbins and Cotran Pathologic Basis of Disease and Robbins Basic Pathology. She has a major interest in pathologic/radiologic correlation and has published widely in this area. A current area of interest is developing open access internet pathology teaching education tailored for pathologists in countries with limited resources.

Objectives

After this presentation, participants will be able to:

Describe the importance of and indications for neoadjuvant treatment in breast cancer
Appropriately evaluate and report the pre-treatment diagnostic breast core needle biopsy and lymph node histopathologic findings in patients with breast cancer
With the incorporation of pre- and post-treatment clinical and radiologic data, grossly evaluate and ensure appropriate tissue sampling of the post-treatment excision specimen
Accurately assess and report response to treatment and understand how RCB vs AJCC Classification systems compare when applied to the reporting process