title: A central review of histopathology reports after breast cancer neoadjuvant chemotherapy in the neo-tango trial.
abstract: BACKGROUND
  Neo-tAnGo, a National Cancer Research Network (NCRN) multicentre randomised neoadjuvant chemotherapy trial in early breast cancer, enroled 831 patients in the United Kingdom. We report a central review of post-chemotherapy histopathology reports on the surgical specimens, to assess the presence and degree of response.
  
  
  METHODS
  A central independent two-reader review (EP and HME) of histopathology reports from post-treatment surgical specimens was performed. The quality and completeness of pathology reporting across all centres was assessed. The reviews included pathological response to chemotherapy (pathological complete response (pCR); minimal residual disease (MRD); and lesser degrees of response), laterality, the number of axillary metastases and axillary nodes, and the type of surgery. A consensus was reached after discussion.
  
  
  RESULTS
  In all, 825 surgical reports from 816 patients were available for review. Out of 4125 data items there were 347 discrepant results (8.4% of classifications), which involved 281 patients. These involved grading of breast response (169 but only 9 involving pCR vs MRD); laterality (6); presence of axillary metastasis (35); lymph node counts (108); and type of axillary surgery (29). Excluding cases with pCR, only 45% of reports included any comment regarding response in the breast and 30% in the axillary lymph nodes.
  
  
  CONCLUSIONS
  We found considerable variability in the completeness of reporting of surgical specimens within this national neoadjuvant breast cancer trial. This highlights the need for consensus guidelines among trial groups on histopathology reporting, and the participation of histopathologists throughout the development and analysis of neoadjuvant trials.
authors.affiliation: Department of Oncology Box 193, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. elena.provenzano@focuspathology.com.au
authors.forename: E
authors.initials: E
authors.lastname: Provenzano
authors.forename: A-L
authors.initials: AL
authors.lastname: Vallier
authors.forename: R
authors.initials: R
authors.lastname: Champ
authors.forename: K
authors.initials: K
authors.lastname: Walland
authors.forename: S
authors.initials: S
authors.lastname: Bowden
authors.forename: A
authors.initials: A
authors.lastname: Grier
authors.forename: N
authors.initials: N
authors.lastname: Fenwick
authors.forename: J
authors.initials: J
authors.lastname: Abraham
authors.forename: M
authors.initials: M
authors.lastname: Iddawela
authors.forename: C
authors.initials: C
authors.lastname: Caldas
authors.forename: L
authors.initials: L
authors.lastname: Hiller
authors.forename: J
authors.initials: J
authors.lastname: Dunn
authors.forename: H M
authors.initials: HM
authors.lastname: Earl
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual / Q000473:pathology; D011379:Prognosis; D012107:Research Design / Q000706:statistics & numerical data*; D016896:Treatment Outcome