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Neoadjuvant chemotherapy


In this section I review briefly specimen handling and reporting of carcinomas treated with neoadjuvant chemotherapy:


Background





The general principles of specimen handling in this context are no different from standard breast cancer specimens

Wide local excisions and mastectomies:

General features



Histological evaluation



As a routine the excised (post-chemo) tumour should be compared with the pre-treatment core for cellularity and grade


The following is suggested as an approach to writing a report on a neoadjuvant case:



An approach which is gaining in popularity is the Residual Cancer Burden (RCB) devised by Symmans1 and colleagues:





The images below show a partial response in the breast following neoadjuvant chemotherapy. 'Mouse over' for more detail.


breast cancer - partial response to neoadjuvant chemotherapy

These images show a near-complete response in an axillary node following neoadjuvant chemotherapy. 'Mouse over' for more detail

lymph node - near-complete response to neoadjuvant chemotherapy



We have previously published2 on the relatively specific pattern of response of some breast cancers to neoadjuvant endocrine therapy, particularly aromatase inhibitors. We found a pattern of central scarring in 60% of cases:

Central scarring in a breast carcinoma treated with neoadjuvant endocrine therapy. The 'Mouse over' shows further detail and the arrow points to the tissue marker site with a florid foreign body reaction.

breast cancer - partial response to neoadjuvant chemotherapy


Two recent 'Images of the Quarter' illustrated patterns of response in axillary nodes following neoadjuvant chemotherapy:

See Image of the Quarter 2015 #3 (complete nodal response) and Image of the Quarter 2015 #4 (partial nodal response)


References:

1. Symmans WF et al. Measurement of Residual Breast Cancer Burden to Predict Survival After Neoadjuvant Chemotherapy. Journal of Clinical Oncology 2007; 25:4414-4422

2. Thomas J et al. Histopathology of breast carcinoma following neoadjuvant systemic therapy: a common association between letrozole therapy and central scarring. Histopathology 2007; 51:219-226


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