Journal Article
. 2020 Nov; 34(Suppl 1):94-106.
doi: 10.1038/s41379-020-00704-7.

Prognostic and predictive parameters in breast pathology: a pathologist's primer

Kimberly H Allison 1 
  • PMID: 33154551
  •     125 References


The pathologist's role in the breast cancer treatment team has evolved from rendering a diagnosis of breast cancer, to providing a growing list of prognostic and predictive parameters such that individualized treatment decisions can be made based on likelihood of benefit from additional treatments and potential benefit from specific therapies. In all stages, ER and HER2 status help segregate breast cancers into treatment groups with similar outcomes and treatment response rates, however, traditional pathologic parameters such as favorable histologic subtype, size, lymph node status, and Nottingham grade also have remained clinically relevant in early stage disease decision-making. This is especially true for the most common subtype of breast cancer; ER positive, HER2 negative disease. For this same group of breast cancers, an ever-expanding list of gene-expression panels also can provide prediction and prognostication about potential chemotherapy benefit beyond standard endocrine therapies, with the 21-gene Recurrence Score, currently the only prospectively validated predictive test for this purpose. In the more aggressive ER-negative cancer subtypes, response to neoadjuvant therapy and` the extent of tumor infiltrating lymphocytes (TILs) are more recently recognized powerful prognostic parameters, and clinical guidelines now offer additional treatment options for those high-risk patients with residual cancer after standard neoadjuvant therapy. In stage four disease, predictive tests like germline BRCA status, tumor PIK3CA mutation status (in ER+ metastatic disease) and PDL-1 status (in triple negative metastatic disease) are now used to determine additional new treatment options. The objective of this review is to describe the latest in prognostic and predictive parameters in breast cancer as they are relevant to standard pathology reporting and how they are used in breast cancer clinical treatment decisions.

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V Bossuyt, E Provenzano, +18 authors, Breast International Group-North American Breast Cancer Group (BIG-NABCG) collaboration.
Ann Oncol, 2015 May 29; 26(7). PMID: 26019189    Free PMC article.
Comparison of residual cancer burden, American Joint Committee on Cancer staging and pathologic complete response in breast cancer after neoadjuvant chemotherapy: results from the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657).
Jeffrey I Campbell, Christina Yau, +12 authors, Yunn-Yi Chen.
Breast Cancer Res Treat, 2017 Jun 04; 165(1). PMID: 28577078    Free PMC article.
Validation of Residual Cancer Burden as Prognostic Factor for Breast Cancer Patients After Neoadjuvant Therapy.
Hannah Deborah Müller, Florian Posch, +9 authors, Marija Balic.
Ann Surg Oncol, 2019 Aug 28; 26(13). PMID: 31452052    Free PMC article.
Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group.
Elena Provenzano, Veerle Bossuyt, +17 authors, Residual Disease Characterization Working Group of the Breast International Group-North American Breast Cancer Group Collaboration.
Mod Pathol, 2015 Jul 25; 28(9). PMID: 26205180
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Prognostic Value of Residual Disease after Neoadjuvant Therapy in HER2-Positive Breast Cancer Evaluated by Residual Cancer Burden, Neoadjuvant Response Index, and Neo-Bioscore.
Tessa G Steenbruggen, Maartje van Seijen, +6 authors, Gabe S Sonke.
Clin Cancer Res, 2019 May 12; 25(16). PMID: 31076546
Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype.
W Fraser Symmans, Caimiao Wei, +17 authors, Gabriel N Hortobagyi.
J Clin Oncol, 2017 Jan 31; 35(10). PMID: 28135148    Free PMC article.
Highly Cited.
Update on tumor-infiltrating lymphocytes (TILs) in breast cancer, including recommendations to assess TILs in residual disease after neoadjuvant therapy and in carcinoma in situ: A report of the International Immuno-Oncology Biomarker Working Group on Breast Cancer.
Maria Vittoria Dieci, Nina Radosevic-Robin, +26 authors, International Immuno-Oncology Biomarker Working Group on Breast Cancer.
Semin Cancer Biol, 2017 Oct 13; 52(Pt 2). PMID: 29024776
Highly Cited. Review.
Prognostic implications of residual disease tumor-infiltrating lymphocytes and residual cancer burden in triple-negative breast cancer patients after neoadjuvant chemotherapy.
S J Luen, R Salgado, +14 authors, S Loi.
Ann Oncol, 2018 Dec 28; 30(2). PMID: 30590484
Tumor infiltrating lymphocytes are prognostic in triple negative breast cancer and predictive for trastuzumab benefit in early breast cancer: results from the FinHER trial.
S Loi, S Michiels, +13 authors, C Sotiriou.
Ann Oncol, 2014 Mar 13; 25(8). PMID: 24608200
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