The Changing Role of Pathology in Breast Cancer Diagnosis and Treatment

Abstract

Pathological examination has been the gold standard for diagnosis in cancer and its role has also included the elucidation of etiology, pathogenesis, clinicopathological correlation, and prognostication. The advent of newer technologies and the realization that breast cancer is heterogeneous has shifted the focus to prognostication, with increased attention being paid to the identification of morphological features and immunohistochemical markers of prognostic relevance. However, despite the massive efforts invested in the identification of immunohistochemical biomarkers in breast cancer the majority have not proven to be of value in multivariate analyses and only estrogen receptor, progesterone receptor, and Her2/neu expression have remained essential components of pathological examination. These 3 markers were initially employed for prognostication but their role in treatment also rendered them of predictive value. Newer molecular methods, especially high-throughput technologies, have shown that even morphologically similar subtypes of breast cancer can show molecular heterogeneity; moreover, infiltrating ductal carcinoma can be separated into at least 4 molecular subtypes designated luminal (ER+, PR+, and Her2/neu–), Her2 overexpressing (ER–, PR–, and Her2/neu+), basal-like (ER–, PR–, Her2/neu–, and CK5/6+, EGFR+), and normal breast-like (ER–, PR–, and Her2/neu–), each with different clinical outcomes. The importance of proliferative gene expression in these subtypes has been demonstrated and surrogate immunohistochemical markers include ER, PR, Her2/neu, and Ki67 for the more expensive molecular tests. Molecular technologies, importantly, have not only provided further insights into the heterogeneity of breast cancer but have also opened new avenues for treatment through the identification of signaling molecules important in the proliferation and survival of the neoplastic cells. The treatment of cancer thus shifts from the conventional approach of ‘one size fits all’ to one of personalized treatment tailored to the specific characteristics of the tumor. Pathologists continue to play their traditional role in diagnosis but, as purveyors of the excised tissue, pathologists now have the additional role of identifying biomarkers responsive to therapeutic manipulation, thus playing an inextricable role as diagnostic oncologists in the management of breast cancer.

Significance of ERα, HER2, and CAV1 expression and molecular subtype classification to canine mammary gland tumor

“…4,21,32 Previous studies focusing on the molecular expression of ERα and PR in HBC have shown the behavior of the 2 molecules to be very similar, possibly because PR expression is strongly dependent on ERα. 14,19,25 In addition, immunohistochemical (IHC) staining for PR is less consistent compared to ERα. 18 In the current study, ERα was used as an indicator for HR expression.…”

Peranan Patologi Dalam Diagnostik Tumor Payudara

“…8 Indikasi pemeriksaan potong beku adalah untuk menetapkan diagnosis dari lesi payudara sebelum dilakukan terapi defenitif serta untuk mengevaluasi margin reseksi. 8 4 Secara tradisional, patolog melalukan pemeriksaan makroskopik dan mikroskopik dari spesimen eksisi yang diterima. Secara makroskopik penilaian dilakukan terhadap integritas spesimen, ukuran spesimen, ukuran tumor, focalitas tumor, perluasan tumor secara makroskopik, dan jumlah kelenjar limfe yang diperiksa.…”

“…Hal ini juga membuka peranan baru patologi dalam prognostik dan tatalaksana kanker payudara. 4 Daftar Pustaka…”

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

“…In this ever-changing era in the diagnosis and treatment of breast cancer, pathologists, the keepers and purveyors of excised tissues, have extended their role by employing new technologies to examine the molecular complexities of breast cancer relating thus its biological heterogeneity to prognosis and treatment, and issuing recommendations aiming to improve the handling and reporting of the specimens [20]. With this paper we aspire to contribute positively to this global effort of post-NAST breast cancer specimens reporting standardization by looking into the Spanish reality of daily practice of accurately defining pCR.…”