Skip to main content
SpringerLink
Log in

Pathology After Neoadjuvant Treatments

  • Chapter
  • First Online:
Breast Cancer

  • 124k Accesses

Abstract

The main objective is to accurately identify the sites of primary tumor bed (that may or may not contain residual cancer cells) and any residual lymph node metastases, so that the extent of residual cancer can be measured and reported. Of course, the tumor bed can become very subtle after effective neoadjuvant chemotherapy, and improving treatments make this ever more likely. Posttreatment residual disease is often detected by light palpation of the sliced breast specimen even more easily than it is observed by visual inspection. Sometimes that is in an area of ill-defined fibrosis. Fortunately, the communication between pathologists, surgeons, and radiologists has greatly improved and, combined with innovations in preoperative localization, has greatly improved the precision of pathologic evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Provenzano E, Bossuyt V, Viale G et al (2015) Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group. Mod Pathol 28:1185–1201

    Article  PubMed  Google Scholar 

  2. Bossuyt V, Provenzano E, Symmans WF et al (2015) Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration. Ann Oncol 26:1280–1291

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Boughey JC, Suman VJ, Mittendorf EA et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 310:1455–1461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Caudle AS, Yang WT, Krishnamurthy S et al (2016) Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol 34:1072–1078

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Symmans WF, Peintinger F, Hatzis C et al (2007) Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol 25:4414–4422

    Article  PubMed  Google Scholar 

  6. Prowell T (2014) Pathologic complete response in neoadjuvant treatment of high-risk early-stage breast cancer: use as an endpoint to support accelerated approval; guidance for industry; availability. Fed Regist 79:60476–60477

    Google Scholar 

  7. Bear H, Anderson S, Brown A et al (2003) The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and bowel project protocol B-27. J Clin Oncol Off J Am Soc Clin Oncol 21:4165–4174

    Article  CAS  Google Scholar 

  8. Bear HD, Anderson S, Smith RE et al (2006) Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer:National Surgical Adjuvant Breast and bowel project protocol B-27. J Clin Oncol 24:2019–2027

    Article  CAS  PubMed  Google Scholar 

  9. Green MC, Buzdar AU, Smith T et al (2005) Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol Off J Am Soc Clin Oncol 23:5983–5992

    Article  CAS  Google Scholar 

  10. Buzdar AU, Ibrahim NK, Francis D et al (2005) Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 23:3676–3685

    Article  CAS  PubMed  Google Scholar 

  11. Gianni L, Eiermann W, Semiglazov V et al (2010) Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet 375:377–384

    Article  CAS  PubMed  Google Scholar 

  12. Mamounas EP, Bryant J, Lembersky B et al (2005) Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer: results from NSABP B-28. J Clin Oncol 23:3686–3696

    Article  CAS  PubMed  Google Scholar 

  13. Henderson IC, Berry DA, Demetri GD et al (2003) Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 21:976–983

    Article  CAS  PubMed  Google Scholar 

  14. Sparano JA, Zhao F, Martino S et al (2015) Long-term follow-up of the E1199 phase III trial evaluating the role of taxane and schedule in operable breast cancer. J Clin Oncol 33:2353–2360

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Romond EH, Perez EA, Bryant J et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 353:1673–1684

    Article  CAS  PubMed  Google Scholar 

  16. Gianni L, Eiermann W, Semiglazov V et al (2014) Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol 15:640–647

    Article  CAS  PubMed  Google Scholar 

  17. DeMichele A, Yee D, Berry DA et al (2015) The neoadjuvant model is still the future for drug development in breast cancer. Clin Cancer Res 21:2911–2915

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Korn EL, Sachs MC, McShane LM (2016) Statistical controversies in clinical research: assessing pathologic complete response as a trial-level surrogate end point for early-stage breast cancer. Ann Oncol 27:10–15

    Article  CAS  PubMed  Google Scholar 

  19. Berry DA (2016) Right-sizing adjuvant and neoadjuvant clinical trials in breast cancer. Clin Cancer Res 22:3–5

    Article  CAS  PubMed  Google Scholar 

  20. Bossuyt V, Hatzis C (2016) The neoadjuvant model and complete pathologic response in breast cancer: all or nothing? JAMA Oncol 2:760–761

    Article  PubMed  Google Scholar 

  21. Cortazar P, Zhang L, Untch M et al (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384:164–172

    Article  PubMed  Google Scholar 

  22. Pocock SJ, Clayton TC, Altman DG (2002) Survival plots of time-to-event outcomes in clinical trials: good practice and pitfalls. Lancet 359:1686–1689

    Article  PubMed  Google Scholar 

  23. Carey LA, Metzger R, Dees EC et al (2005) American joint committee on cancer tumor-node-metastasis stage after neoadjuvant chemotherapy and breast cancer outcome. J Natl Cancer Inst 97:1137–1142

    Article  PubMed  Google Scholar 

  24. von Minckwitz G, Untch M, Blohmer JU et al (2012) Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 30:1796–1804

    Article  Google Scholar 

  25. Peintinger F, Sinn B, Hatzis C et al (2015) Reproducibility of residual cancer burden for prognostic assessment of breast cancer after neoadjuvant chemotherapy. Mod Pathol 28:913–920

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ogston KN, Miller ID, Payne S et al (2003) A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast 12:320–327

    Article  PubMed  Google Scholar 

  27. Rajan R, Poniecka A, Smith TL et al (2004) Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response. Cancer 100:1365–1373

    Article  PubMed  Google Scholar 

  28. Yi M, Mittendorf EA, Cormier JN et al (2011) Novel staging system for predicting disease-specific survival in patients with breast cancer treated with surgery as the first intervention: time to modify the current American joint committee on cancer staging system. J Clin Oncol 29:4654–4661

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mittendorf EA, Jeruss JS, Tucker SL et al (2011) Validation of a novel staging system for disease-specific survival in patients with breast cancer treated with neoadjuvant chemotherapy. J Clin Oncol 29:1956–1962

    Article  PubMed  PubMed Central  Google Scholar 

  30. Marme F, Lederer B, Blohmer JU et al (2016) Utility of the CPS+EG staging system in hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer treated with neoadjuvant chemotherapy. Eur J Cancer 53:65–74

    Article  CAS  PubMed  Google Scholar 

  31. Mittendorf EA, Vila J, Tucker SL et al (2016) The neo-Bioscore update for staging breast cancer treated with neoadjuvant chemotherapy: incorporation of prognostic biologic factors into staging after treatment. JAMA Oncol 2:929–936

    Article  PubMed  Google Scholar 

  32. Symmans WF, Hatzis C, Sotiriou C et al (2010) A genomic index of sensitivity to endocrine therapy of breast cancer. J Clin Oncol 28:4111–4119

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sheri A, Smith IE, Johnston SR et al (2015) Residual proliferative cancer burden to predict long-term outcome following neoadjuvant chemotherapy. Ann Oncol 26:75–80

    Article  CAS  PubMed  Google Scholar 

  34. Dieci MV, Criscitiello C, Goubar A et al (2014) Prognostic value of tumor-infiltrating lymphocytes on residual disease after primary chemotherapy for triple-negative breast cancer: a retrospective multicenter study. Ann Oncol 25:611–618

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Balko JM, Giltnane JM, Wang K et al (2014) Molecular profiling of the residual disease of triple-negative breast cancers after neoadjuvant chemotherapy identifies actionable therapeutic targets. Cancer Discov 4:232–245

    Article  CAS  PubMed  Google Scholar 

  36. Balko JM, Schwarz LJ, Luo N et al (2016) Triple-negative breast cancers with amplification of JAK2 at the 9p24 locus demonstrate JAK2-specific dependence. Sci Transl Med 8:334ra53

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mittendorf EA, Wu Y, Scaltriti M et al (2009) Loss of HER2 amplification following trastuzumab-based neoadjuvant systemic therapy and survival outcomes. Clin Cancer Res 15:7381–7388

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Ellis MJ, Tao Y, Luo J et al (2008) Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. J Natl Cancer Inst 100:1380–1388

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Unit 85, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA

    W. Fraser Symmans M.D.

Authors
  1. W. Fraser Symmans M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Fraser Symmans M.D. .

Editor information

Editors and Affiliations

  1. European Institutee of Oncology, Milan, Italy

    Umberto Veronesi

  2. European Institute of Oncology, Milan, Italy

    Aron Goldhirsch

  3. European Institute of Oncology, Milan, Italy

    Paolo Veronesi

  4. San Raffaele University and Research Hospital, Milano, Italy

    Oreste Davide Gentilini

  5. European Institute of Oncology, Milan, Italy

    Maria Cristina Leonardi

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fraser Symmans, W. (2017). Pathology After Neoadjuvant Treatments. In: Veronesi, U., Goldhirsch, A., Veronesi, P., Gentilini, O., Leonardi, M. (eds) Breast Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-48848-6_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-48848-6_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-48846-2

  • Online ISBN: 978-3-319-48848-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation