Mohammad Faisal, Madiha Ehsan-ul Haq, Hina Tariq, Nadira Mamoon.
Determination of Tumor Pathological Response in Post-Neoadjuvant Chemotherapy Breast Carcinoma Resection Specimens.
J Sharif Med Dent Coll Jan ;4(02):55-60.

Objective: To determine the tumor pathological response in post-neoadjuvant chemotherapy resected breast carcinoma specimens. Methodology: It was a cross-sectional study conducted in the Department of Histopathology, Shifa International Hospital (SIH), Islamabad from 1st October 2014 to 30 April 2016. The study was approved by the Hospital ethics committee. All formalin fixed resection specimens with or without axillary lymph nodes dissection (ALND) were processed according to the standardized grossing techniques. Slides were prepared from the tissue blocks. Previous biopsies were reviewed for assessment of neoadjuvant chemotherapy (NACT) response using Pinder et al. system for pathological response. Results were verified by another consultant histopathologist. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 24.0. Results: A total of 77 previously diagnosed patients who received NACT were analyzed. Seventy five (97.4%) cases underwent modified radical mastectomy (MRM) with ALND and 2(2.6%) cases had a lumpectomy with ALND. All of the cases were females. The age range was 26 75 years (48.55+11.66 years). Clinical/radiological tumor size was 1.1 to 16.0 cm (4.68+2.63 cm). Invasive mammary carcinoma of no special type was the commonest tumor type and was seen in 73(94.8%) cases. Most of the cases of invasive mammary carcinoma of no special type 53(72.6%) showed partial response while 10(13.7%) cases had complete pathological response (CPR) and 10(13.7%) had no response. Post NACT tumor histological grade I was identified in 2 cases (3.0%), grade II in 46 cases (68.6%) and grade III in 19 cases (28.4%). Post-NACT grade could not be assessed in 10 cases due to cPR. In MRM specimen after NACT, there was no residual tumor in 11(14.3%) cases and no significant decrease in cellularity in 9(11.7%). Tumor cellularity of <10% partial pathological response (PPR) was noticed in 15(19.5%), 10 50% cellularity (PPR) in 19(24.7%) of cases and >50% of cellularity (PPR) in 22(28.5%) cases. No evidence of metastatic disease and no evidence of response in lymph nodes (LN) was seen in 14 cases (18.2%) while 27 cases (35%) had the metastatic disease but no evidence of response. In 11 cases (14.3%), no metastatic tumor was present, however, histological features of NACT response were observed. Rest of 25 cases (32.5%) had metastatic carcinoma along with the evidence of response. Conclusion: Breast carcinoma showed a good response to neoadjuvant chemotherapy with the majority of the cases showing partial pathological response in both breast and lymph nodes. The response in both breast and lymph nodes was not found to be related to age or histologic grade. Invasive mammary carcinoma of no special type was the commonest tumor with the majority of cases showing grade II category of tumor. Keywords: Breast carcinoma. Lymph node. Neoadjuvant chemotherapy. Pathological response.

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