title: [Neoadjuvant treatment of breast cancer: implications for the pathologist].
abstract: These past few years, neoadjuvant strategy has taken an increasing place in the management of breast cancer patients. This strategy is mainly indicated to obtain a tumour bulk regression allowing a breast conserving surgery in patients that otherwise would have undergone mastectomy. Of note, development of new chemotherapy agents and targeted therapies has critically helped in the progress of neoadjuvant strategy as it is currently associated with better pathological response rates. In this context, the pathologist is at the crossroad of this multidisciplinary process. First, he provides on the initial core needle biopsy the tumour pathological characteristics that are critical for the choice of treatment strategy, i.e. histological type, histological grade, proliferative activity (mitotic count and Ki67/MIB1 index labeling), hormone receptor status (oestrogen receptor and progesterone receptor) and HER2 status. Secondly, the pathologist evaluates the pathological response and the status of surgical margins with regards to the residual tumour on the surgical specimen after neoadjuvant treatment. These parameters are important for the management of the patient, since it has been shown that complete pathological response is associated with improved disease free survival. Several grading systems are used to assess the pathological response in breast and axillary lymph nodes. The most frequently used in France are currently the systems described by Sataloff et al. and Chevallier et al. In this review, we detail the different steps involving the pathologist in neoadjuvant setting, with special regards to the quality process and future perspectives such as emerging predictive biomarkers.
authors.affiliation: Département de biologie et de pathologie, institut Claudius-Regaud, Toulouse cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Le Guellec
authors.forename: Romain
authors.initials: R
authors.lastname: Perallon
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Alunni
authors.forename: Hélène
authors.initials: H
authors.lastname: Charitansky
authors.forename: Christina
authors.initials: C
authors.lastname: Leaha
authors.forename: Aurélie Maran
authors.initials: AM
authors.lastname: Gonzalez
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Chateau
authors.forename: Joelle
authors.initials: J
authors.lastname: Simony-Lafontaine
authors.forename: William
authors.initials: W
authors.lastname: Jacot
authors.forename: Marian
authors.initials: M
authors.lastname: Gutowski
authors.forename: Frédérique
authors.initials: F
authors.lastname: Penault-Llorca
authors.forename: Florence
authors.initials: F
authors.lastname: Dalenc
authors.forename: Magali
authors.initials: M
authors.lastname: Lacroix-Triki
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D004967:Estrogens; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D033183:Interdisciplinary Communication; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009376:Neoplasms, Hormone-Dependent / Q000473:pathology / Q000628:therapy; D010338:Pathology, Clinical; D010819:Physician's Role; D011379:Prognosis; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D004967:Estrogens