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

• O. Burgués ^[3] ; Mª. Á. López-García ^[4] ; B. Pérez-Míes ^[1] ; P. Santiago ^[5] ; B. Vieites ^[4] ; J. F. García ^[6] ; V. Peg ^[2]
  1. [1] Hospital Ramón y Cajal

     Hospital Ramón y Cajal

     Madrid, España

     
  2. [2] Hospital Vall d'Hebron

     Hospital Vall d'Hebron

     Barcelona, España

     
  3. [3] Hospital Clínico Universitario Valencia, España
  4. [4] Hospital Virgen Del Rocío, España
  5. [5] Complejo Hospitalario A Coruña, España
  6. [6] Roche Farma S.A., Madrid, España

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 20, Nº. 3 (March 2018), 2018, págs. 382-391
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Purpose To compare the current international standards for neoadjuvant systemic therapy (NAST) protocols, and establish consensus recommendations by Spanish breast pathologists; and to look into the Spanish reality of defining pathological complete response in daily practice.

    Materials and methods A modified Delphi technique was used to gain consensus among a panel of 46 experts with regard to important issues about NAST specimens, with the objective of standardize handling and analysis of these breast cancer specimens. In addition, a survey was conducted among 174 pathologists to explore the Spanish reality of post-NAST breast cancer specimens handling.

    Results Our survey shows that pathologists in Spain follow the same guidelines as their international colleagues and face the same problems and controversies. Among the experts, 94.1% agreed on the recommendation for a pre-treatment evaluation with a core needle biopsy, and 100% of experts agreed on the need of having properly indicated information for the post-NAST surgical specimens. However, only 82.7% of them receive properly labelled specimens and even less receive specimens where markers are identified and the degree of clinical/radiological response is mentioned. Among participants 59.9% were familiar with the residual cancer burden system for post-NAST response quantification, but only 16.1% used it regularly.

    Conclusions Active participation on breast cancer multidisciplinary teams, optimal usage of core needle biopsy for timely and standardized procedures for the diagnostic analysis, and accurate diagnosis of pathological complete response and complete evaluation of the response to NAST need to become the standard practice when handling breast cancer specimens in Spain.