TY - JOUR
T1 - Standardizing Pathologic Evaluation of Breast Carcinoma After Neoadjuvant Chemotherapy
AU - the I-SPY Pathology Working Group
AU - Sahoo, Sunati
AU - Krings, Gregor
AU - Chen, Yunn Yi
AU - Carter, Jodi M.
AU - Chen, Beiyun
AU - Guo, Hua
AU - Hibshoosh, Hanina
AU - Reisenbichler, Emily
AU - Fan, Fang
AU - Wei, Shi
AU - Khazai, Laila
AU - Balassanian, Ronald
AU - Klein, Molly E.
AU - Shad, Sonal
AU - Venters, Sara J.
AU - Borowsky, Alexander D.
AU - Fraser Symmans, W.
AU - Tolgay Ocal, I.
N1 - Publisher Copyright:
© 2023 College of American Pathologists. All rights reserved.
PY - 2023/5
Y1 - 2023/5
N2 - Context.-Neoadjuvant systemic therapy refers to the use of systemic agent(s) for malignancy prior to surgical treatment and has recently emerged as an option for most breast cancer patients eligible for adjuvant systemic therapy. Consequently, treated breast carcinomas have become routine specimens in pathology practices. A standard protocol has not yet been universally adopted for the evaluation and reporting of these specimens. The American Joint Committee on Cancer staging system recognizes the challenges in staging breast carcinomas after neoadjuvant treatment and provides important data points but does not currently provide detailed guidance in estimating the residual tumor burden in the breast and lymph nodes. The Residual Cancer Burden system is the only Web-based system that quantifies treatment response as a continuous variable using residual tumor burden in the breast and the lymph nodes. Objective.-To provide clarifications and guidance for evaluation and reporting of postneoadjuvant breast specimens, discuss issues with the current staging and reporting systems, and provide specific suggestions for future modifications to the American Joint Committee on Cancer system and the Residual Cancer Burden calculator. Data Sources.-English-language literature on the subject and the data from the I-SPY 2, a multicenter, adaptive randomization phase 2 neoadjuvant platform trial for early-stage, high-risk breast cancer patients. Conclusions.-This article highlights challenges in the pathologic evaluation and reporting of treated breast carcinomas and provides recommendations and clarifications for pathologists and clinicians. It also provides specific recommendations for staging and discusses future directions.
AB - Context.-Neoadjuvant systemic therapy refers to the use of systemic agent(s) for malignancy prior to surgical treatment and has recently emerged as an option for most breast cancer patients eligible for adjuvant systemic therapy. Consequently, treated breast carcinomas have become routine specimens in pathology practices. A standard protocol has not yet been universally adopted for the evaluation and reporting of these specimens. The American Joint Committee on Cancer staging system recognizes the challenges in staging breast carcinomas after neoadjuvant treatment and provides important data points but does not currently provide detailed guidance in estimating the residual tumor burden in the breast and lymph nodes. The Residual Cancer Burden system is the only Web-based system that quantifies treatment response as a continuous variable using residual tumor burden in the breast and the lymph nodes. Objective.-To provide clarifications and guidance for evaluation and reporting of postneoadjuvant breast specimens, discuss issues with the current staging and reporting systems, and provide specific suggestions for future modifications to the American Joint Committee on Cancer system and the Residual Cancer Burden calculator. Data Sources.-English-language literature on the subject and the data from the I-SPY 2, a multicenter, adaptive randomization phase 2 neoadjuvant platform trial for early-stage, high-risk breast cancer patients. Conclusions.-This article highlights challenges in the pathologic evaluation and reporting of treated breast carcinomas and provides recommendations and clarifications for pathologists and clinicians. It also provides specific recommendations for staging and discusses future directions.
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U2 - 10.5858/ARPA.2022-0021-EP
DO - 10.5858/ARPA.2022-0021-EP
M3 - Article
C2 - 35976643
AN - SCOPUS:85159541507
SN - 0003-9985
VL - 147
SP - 591
EP - 603
JO - Archives of Pathology and Laboratory Medicine
JF - Archives of Pathology and Laboratory Medicine
IS - 5
ER -