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Breast specimen handling and reporting in the post-neoadjuvant setting: challenges and advances
  1. Miralem Mrkonjic1,2,
  2. Hal K Berman1,2,
  3. Susan J Done1,2,
  4. Bruce Youngson1,2,
  5. Anna Marie Mulligan1,2
  1. 1 Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
  2. 2 Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Anna Marie Mulligan, Laboratory Medicine Program, University Health Network, Toronto, ON M5G 2C4, Canada; annamarie.mulligan{at}


Neoadjuvant systemic therapy is becoming more commonly used in patients with earlier stages of breast cancer. To assess tumour response to neoadjuvant chemotherapy, pathological evaluation is the gold standard. Depending on the treatment response, the pathological examination of these specimens can be quite challenging. However, a uniform approach to evaluate post-neoadjuvant-treated breast specimens has been lacking. Furthermore, there is no single universally accepted or endorsed classification system for assessing treatment response in this setting. Recent initiatives have attempted to create a standardised protocol for evaluation of post-neoadjuvant breast specimens. This review outlines the necessary information that should be collected prior to macroscopic examination of these specimens, the recommended and most pragmatic approach to tissue sampling for microscopic examination, describes the macroscopic and microscopic features of post-therapy breast specimens, summarises two commonly used systems for classifying treatment response and outlines the critical variables that should be included in the final pathology report.

  • breast pathology
  • neoadjuvant
  • macroscopic
  • microscopic
  • reporting
  • treatment response

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  • Handling editor Runjan Chetty.

  • Contributors All authors listed contributed to this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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