Pathological consideration in the neoadjuvant setting


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Abeer Shaaban1
1NIHR Clinical Research Network: West Midlands

Abstract

Background

Neoadjuvant chemotherapy is increasingly being used for the management of inflammatory breast cancer, locally advanced and large operable breast cancer. Pathology plays a pivotal role in selecting suitable patients for chemotherapy and preoperative trials by providing tumour grade hormone receptor and HER2 status. In addition, pathologists assess the degree of pathological response in breast and axillary nodes following surgery thus providing important prognostic and predictive information. It is therefore essential for the clinical teams to receive the cancer diagnosis with receptor and HER2 results in a timely fashion. Current NICE guidance requires the availability of ER and HER2 results within 2 weeks for management purposes. Ideally, those results should be made available to the MDT team at the first diagnostic MDT to enable clinical decisions to be made. While there is extensive quality control of HER2 staining and interpretation, there is little guidance to pathologists on how to achieve fast turnaround time for HER2 testing. Some hospitals considered but declined participating in pre-operative trials because of the prolonged HER2 turnaround time. The Translational Subgroup of the NCRI Breast Clinical Studies Group provided clinical pathways that can be adopted at local pathology departments to enable fast testing (1). Reference 1.Shaaban AM, Purdie CA, Bartlett JM, Stein RC, Lane S, Francis A, et al. HER2 testing for breast carcinoma: recommendations for rapid diagnostic pathways in clinical practice. Journal of clinical pathology. 2014;67(2):161-7.