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.Conclusion: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.

Central pathology review with two-stage quality assurance for pathological response after neoadjuvant chemotherapy in the ARTemis Trial

“…11 It is possible that should such standardisation be adopted, a measure of response such as RCB could be calculated locally. Also, although there is some evidence that pathologists are better at assessing chemotherapy response by reading pathology reports than are practicing clinicians 12 this was not borne out by our data. It was evident on review of some of the cases where there were discrepancies between report-review and central review that this was due to missing slides.…”

The ever-evolving role of pathologists in the management of breast cancer with neoadjuvant treatment: recommendations based on the Spanish clinical experience

“…The last few years NAST is offered more and more often to patients with early breast cancer and it has almost become routine for patients to receive systemic therapy [11,28]. However as a result of NAST, the correlation of clinicopathological and radiological response with residual tumour could not be defined accurately [29], although with the introduction of magnetic resonance the accuracy in discriminating residual disease versus pCR has improved [30].…”

“…Frequently, pathologists in their daily routine practice have to deal with specimens where important parameters for reporting are missing. The neo-tAnGo trial revealed large variations in handling and reporting of post-NAST breast cancer specimens [11].…”

“…Multicenter breast cancer clinical trial studies have indicated that there is a huge variation in handling and reporting these specimens [11], due to the fact that guidelines are not always followed accurately [12]. Currently there are different classification systems with several relevant reviews [13][14][15][16], where recommendations for the assessment of pathologic response to NAST can be found.…”

The Perfect Pathology Report After Neoadjuvant Therapy

“…Neoadjuvant treatment (NAT) has represented a major paradigm shift in the management of breast cancer over the last years and it is increasingly being used (1,2). In the context of clinical trials NAT has offered a unique opportunity for the evaluation of treatment response, with pathological complete response (pCR) acting as a surrogate marker of survival, thus 1) allowing more rapid assessment of the efficacy of new chemotherapeutic agents, 2) enabling early ending of ineffective treatments, and 3) providing an opportunity to individualize patient treatment at early stages (1).…”