Pathologic reporting practices for breast cancer specimens after neoadjuvant chemotherapy—a survey of pathologists in academic institutions across the United States

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Neoadjuvant chemotherapy is increasingly being used to treat primary invasive breast carcinoma. Response to neoadjuvant chemotherapy is an important determinant of prognosis. A multidisciplinary group published recommendations for standardization of pathologic reporting of postneoadjuvant chemotherapy specimens. Based on these recommendations, we sent a survey to 26 pathologists currently practicing breast pathology in academic centers across the United States. The survey consisted of six questions with yes/no answers. The pathologists were encouraged to add comments. We received responses from 23 breast pathologists from 19 centers. The questions and responses were as follows: 1. Do you grade tumors after neoadjuvant chemotherapy?—17 (74%) responded yes and 6 (26%) responded no. 2. Do you routinely repeat hormone receptors, HER2/Neu results after neoadjuvant chemotherapy?—15 (65%) responded yes and 8 (35%) responded no. 3. If there are features of tumor regression/tumor bed at the margin but no actual tumor at the margin do you report this?—11 (48%) responded yes and 8 (35%) responded no and 4 (17%) reported a variable practice. 4. Do you report number of nodes with fibrosis/changes of regression?—17 (74%) responded yes and 6 (26%) responded no. 5. Do you report residual cancer burden score on your report or at least provide information on your report so clinicians can calculate residual cancer burden?—17 (74%) responded yes and 6 (26%) responded no. 6. Do you have a specific synoptic for cases after neoadjuvant chemotherapy?—5 (22%) responded yes and 18 (78%) responded no. The major reasons provided for nonadherence to recommended guidelines included pathologists were unaware of prognostic importance of providing the information, reporting practices were clinician driven and some pathologists were unaware of the recommendation. We document that academic breast pathology practices show significant variability in reporting of postneoadjuvant chemotherapy cases. We document barriers to standard practice and provide recommendations we hope will contribute to a more uniform reporting practice for these complex specimens.

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We acknowledge the pathologists who contributed to this study with their responses to our survey and their comments provided with study questionnaire: Dr. Bryan Harmon, Dr Farbod Darvishian, Dr Michael Gilcrease, Dr. Kimberly Allison, Dr. Hanina Hibshoosh, Dr. Malini Harigopal, Dr. Diane Hamele-Bena, Dr. Ruth Asirvatham, Dr. Julie Jornes, Dr. Bill Li, Dr. Rohit Bhargava, Dr. Raavi Gupta, Dr Shabnam Jaffer, Dr. Paula Ginter, Dr. Kimberly Cole, Dr Sunil Badve, Dr. Susan Lester, Dr. Syed Hoda, Dr. Timothy D’Alfonso. Dr. Yihong Wang, Dr. Fatima Zahra Aly, Dr Stuart Schnitt, Dr Susan Fineberg. We acknowledge editorial assistance provided by Jenna Ansell, and Matthew Shear.

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Correspondence to Susan Fineberg.

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