Pathologic evaluation of specimens after neoadjuvant chemotherapy in breast cancer: Current recommendations and challenges

Sharlene Helene C. See*, Kalliopi P. Siziopikou

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Neoadjuvant chemotherapy is increasingly used to optimize breast conservation surgery and is becoming a standard of care in a subset of breast cancer patients. An accurate pathologic assessment is crucial in guiding clinical decisions and subsequent management and prognosis. This review aims to summarize the most current literature, recommendations, and challenges in the pathologic evaluation of breast cancer after neoadjuvant chemotherapy. Included are the most current definitions of the different types of tumor response, the underlying factors that can affect tumor response, how to assess lymph nodes, margins, and tumor markers post-neoadjuvant chemotherapy, as well as the different classification systems a pathologist can use to assess residual disease. In this era of de-escalation of surgical treatment, studies on imaging techniques to assess residual disease and avoid surgery after neoadjuvant chemotherapy have also been done. However, at least for now, surgical treatment remains the preferred practice. As such, pathologists play an increasingly critical role in standardizing assessment of residual disease post-neoadjuvant chemotherapy, and in optimizing the knowledge gained by this approach to breast cancer therapy.

Original languageEnglish (US)
Article number153753
JournalPathology Research and Practice
StatePublished - Feb 2022


  • Breast cancer
  • Neoadjuvant chemotherapy
  • Pathologic complete response
  • Pathologic partial response
  • Residual cancer burden
  • Residual tumor

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Cell Biology


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