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Clinical Trial
. 2013 Mar 5;108(4):866-72.
doi: 10.1038/bjc.2012.547. Epub 2013 Jan 8.

A central review of histopathology reports after breast cancer neoadjuvant chemotherapy in the neo-tango trial

E Provenzano  1 , A-L Vallier, R Champ, K Walland, S Bowden, A Grier, N Fenwick, J Abraham, M Iddawela, C Caldas, L Hiller, J Dunn, H M Earl
Affiliations
Clinical Trial

A central review of histopathology reports after breast cancer neoadjuvant chemotherapy in the neo-tango trial

E Provenzano et al. Br J Cancer. .

Abstract

Background: Neo-tAnGo, a National Cancer Research Network (NCRN) multicentre randomised neoadjuvant chemotherapy trial in early breast cancer, enroled 831 patients in the United Kingdom. We report a central review of post-chemotherapy histopathology reports on the surgical specimens, to assess the presence and degree of response.

Methods: A central independent two-reader review (EP and HME) of histopathology reports from post-treatment surgical specimens was performed. The quality and completeness of pathology reporting across all centres was assessed. The reviews included pathological response to chemotherapy (pathological complete response (pCR); minimal residual disease (MRD); and lesser degrees of response), laterality, the number of axillary metastases and axillary nodes, and the type of surgery. A consensus was reached after discussion.

Results: In all, 825 surgical reports from 816 patients were available for review. Out of 4125 data items there were 347 discrepant results (8.4% of classifications), which involved 281 patients. These involved grading of breast response (169 but only 9 involving pCR vs MRD); laterality (6); presence of axillary metastasis (35); lymph node counts (108); and type of axillary surgery (29). Excluding cases with pCR, only 45% of reports included any comment regarding response in the breast and 30% in the axillary lymph nodes.

Conclusion: We found considerable variability in the completeness of reporting of surgical specimens within this national neoadjuvant breast cancer trial. This highlights the need for consensus guidelines among trial groups on histopathology reporting, and the participation of histopathologists throughout the development and analysis of neoadjuvant trials.

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Figures

Figure 1
Figure 1
(A) Pre-treatment core biopsy and (B) post-chemotherapy excision specimen showing good response to neoadjuvant chemotherapy with a marked reduction in cellularity following treatment.
Figure 2
Figure 2
Lymph node showing metastasis with response to treatment with a focal area of fibrosis containing haemosiderin laden macrophages.
Figure 3
Figure 3
Comparison of scores of chemotherapy response from reviewer 1 and reviewer 2 with final score. (pCR – pathological complete response: MRD – minimal residual disease: CRNG – chemotherapy response non-gradable: NR – no response: NC – no comment in report on chemotherapy response).
See this image and copyright information in PMC

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