Pathology after neoadjuvant treatments

The main objective is to accurately identify the sites of primary tumor bed (that may or may not contain residual cancer cells) and any residual lymph node metastases, so that the extent of residual cancer can be measured and reported. Of course, the tumor bed can become very subtle after effective neoadjuvant chemotherapy, and improving treatments make this ever more likely. Posttreatment residual disease is often detected by light palpation of the sliced breast specimen even more easily than it is observed by visual inspection. Sometimes that is in an area of ill-defined fibrosis. Fortunately, the communication between pathologists, surgeons, and radiologists has greatly improved and, combined with innovations in preoperative localization, has greatly improved the precision of pathologic evaluation.