Skip to main content
SpringerLink
Log in

Pathology of Breast Cancer

  • Chapter
  • First Online:
Book cover Breast Cancer Management for Surgeons

  • 2589 Accesses

Abstract

The pathologist is involved at various steps in the management of patients with breast cancer, beginning with the confirmation of malignancy and ending with the establishment of prognostic and predictive markers. A close collaboration between surgeons and pathologists is mandatory for proper diagnostics of breast cancer, especially during frozen section analysis, gross tumour examination and evaluation of response to neoadjuvant therapy. The pathology report must contain the histological characteristics of the tumour, the classical prognostic and theranostic markers (stage, receptor profile) as well as the surgical margin status. More recently, prognostic parameters obtained by gene expression analysis may complete the report.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of Tumours of the breast. 4th ed. Lyon: IARC Press; 2012.

    Google Scholar 

  2. Cadoo KA, McArdle O, O'Shea AM, Power CP, Hennessy BT. Management of unusual histological types of breast cancer. Oncologist. 2012;17(9):1135–45.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dieci MV, Orvieto E, Dominici M, Conte P, Guarneri V. Rare breast cancer subtypes: histological, molecular, and clinical peculiarities. Oncologist. 2014;19(8):805–13.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dossus L, Benusiglio PR. Lobular breast cancer: incidence and genetic and non-genetic risk factors. Breast Cancer Res. 2015;17:37.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fortunato L, Mascaro A, Poccia I, Andrich R, Amini M, Costarelli L, et al. Lobular breast cancer: same survival and local control compared with ductal cancer, but should both be treated the same way? Analysis of an institutional database over a 10-year period. Ann Surg Oncol. 2012;19(4):1107–14.

    Article  PubMed  Google Scholar 

  6. Parvaiz MA, Yang P, Razia E, Mascarenhas M, Deacon C, Matey P, et al. Breast MRI in invasive lobular carcinoma: a useful investigation in surgical planning? Breast J. 2016;22(2):143–50.

    Article  PubMed  Google Scholar 

  7. Korhonen T, Kuukasjarvi T, Huhtala H, Alarmo EL, Holli K, Kallioniemi A, et al. The impact of lobular and ductal breast cancer histology on the metastatic behavior and long term survival of breast cancer patients. Breast. 2013;22(6):1119–24.

    Article  CAS  PubMed  Google Scholar 

  8. Diab SG, Clark GM, Osborne CK, Libby A, Allred DC, Elledge RM. Tumor characteristics and clinical outcome of tubular and mucinous breast carcinomas. J Clin Oncol. 1999;17(5):1442–8.

    Article  CAS  PubMed  Google Scholar 

  9. Liu GF, Yang Q, Haffty BG, Moran MS. Clinical-pathologic features and long-term outcomes of tubular carcinoma of the breast compared with invasive ductal carcinoma treated with breast conservation therapy. Int J Radiat Oncol Biol Phys. 2009;75(5):1304–8.

    Article  PubMed  Google Scholar 

  10. Gokce H, Durak MG, Akin MM, Canda T, Balci P, Ellidokuz H, et al. Invasive micropapillary carcinoma of the breast: a clinicopathologic study of 103 cases of an unusual and highly aggressive variant of breast carcinoma. Breast J. 2013;19(4):374–81.

    Article  PubMed  Google Scholar 

  11. Abouharb S, Moulder S. Metaplastic breast cancer: clinical overview and molecular aberrations for potential targeted therapy. Curr Oncol Rep. 2015;17(3):431.

    Article  PubMed  Google Scholar 

  12. Al-Baimani K, Bazzarelli A, Clemons M, Robertson SJ, Addison C, Arnaout A. Invasive pleomorphic lobular carcinoma of the breast: pathologic, clinical, and therapeutic considerations. Clin Breast Cancer. 2015;15(6):421–5.

    Article  PubMed  Google Scholar 

  13. Moore OS Jr, Foote FW Jr. The relatively favorable prognosis of medullary carcinoma of the breast. Cancer. 1949;2(4):635–42.

    Article  PubMed  Google Scholar 

  14. Lakhani SR, Reis-Filho JS, Fulford L, Penault-Llorca F, van der Vijver M, Parry S, et al. Prediction of BRCA1 status in patients with breast cancer using estrogen receptor and basal phenotype. Clin Cancer Res. 2005;11(14):5175–80.

    Article  CAS  PubMed  Google Scholar 

  15. Ollier M, Radosevic-Robin N, Kwiatkowski F, Ponelle F, Viala S, Privat M, et al. DNA repair genes implicated in triple negative familial non-BRCA1/2 breast cancer predisposition. Am J Cancer Res. 2015;5(7):2113–26.

    PubMed  PubMed Central  Google Scholar 

  16. Lord CJ, Ashworth A. BRCAness revisited. Nat Rev Cancer. 2016;16(2):110–20.

    Article  CAS  PubMed  Google Scholar 

  17. Birkbak NJ, Wang ZC, Kim JY, Eklund AC, Li Q, Tian R, et al. Telomeric allelic imbalance indicates defective DNA repair and sensitivity to DNA-damaging agents. Cancer Discov. 2012;2(4):366–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Telli ML, Jensen KC, Vinayak S, Kurian AW, Lipson JA, Flaherty PJ, et al. Phase II study of gemcitabine, carboplatin, and Iniparib as Neoadjuvant therapy for triple-negative and BRCA1/2 mutation-associated breast cancer with assessment of a tumor-based measure of genomic instability: PrECOG 0105. J Clin Oncol. 2015;33(17):1895–901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Telli ML, Timms KM, Reid J, Hennessy B, Mills GB, Jensen KC, et al. Homologous recombination deficiency (HRD) score predicts response to platinum-containing Neoadjuvant chemotherapy in patients with triple-negative breast cancer. Clin Cancer Res. 2016;22(15):3764–73.

    Article  CAS  PubMed  Google Scholar 

  20. Savas P, Salgado R, Denkert C, Sotiriou C, Darcy PK, Smyth MJ, et al. Clinical relevance of host immunity in breast cancer: from TILs to the clinic. Nat Rev Clin Oncol. 2016;13(4):228–41.

    Article  CAS  PubMed  Google Scholar 

  21. van Uden DJ, van Laarhoven HW, Westenberg AH, de Wilt JH, Blanken-Peeters CF. Inflammatory breast cancer: an overview. Crit Rev Oncol Hematol. 2015;93(2):116–26.

    Article  PubMed  Google Scholar 

  22. Bilous M. Breast core needle biopsy: issues and controversies. Mod Pathol. 2010;23(Suppl 2):S36–45.

    Article  PubMed  Google Scholar 

  23. Perry N, Broeders M, de Wolf C, Tornberg S, Holland R, von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition--summary document. Ann Oncol. 2008;19(4):614–22.

    Article  CAS  PubMed  Google Scholar 

  24. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of clinical oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med. 2010;134(7):e48–72.

    CAS  PubMed  Google Scholar 

  25. MacGrogan G, Mathieu MC, Poulet B, Penault-Llorca F, Vincent-Salomon A, Roger P, et al. Pre-analytical stage for biomarker assessment in breast cancer: 2014 update of the GEFPICS' guidelines in France. Ann Pathol. 2014;34(5):366–72.

    Article  PubMed  Google Scholar 

  26. Tamaki Y. One-step nucleic acid amplification (OSNA): where do we go with it? Int J Clin Oncol. 2016.

    Google Scholar 

  27. Powsner SM, Costa J, Homer RJ. Clinicians are from Mars and pathologists are from Venus. Arch Pathol Lab Med. 2000;124(7):1040–6.

    CAS  PubMed  Google Scholar 

  28. Sluijter CE, van Lonkhuijzen LR, van Slooten HJ, Nagtegaal ID, Overbeek LI. The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review. Virchows Arch. 2016;468(6):639–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Vaidya JS, Vyas JJ, Chinoy RF, Merchant N, Sharma OP, Mittra I. Multicentricity of breast cancer: whole-organ analysis and clinical implications. Br J Cancer. 1996;74(5):820–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56(5):979–90.

    Article  CAS  PubMed  Google Scholar 

  31. Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717–30.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383–93.

    Article  PubMed  Google Scholar 

  33. Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thurlimann B, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2013. Ann Oncol. 2013;24(9):2206–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88(3):553–64.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Buchholz TA, Somerfield MR, Griggs JJ, El-Eid S, Hammond ME, Lyman GH, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol. 2014;32(14):1502–6.

    Article  PubMed  Google Scholar 

  36. Edge SB, Byrd DR, Compton CC, editors. AJCC cancer staging manual. 7th ed. New York, NY: Springer; 2010.

    Google Scholar 

  37. Wolters R, Wockel A, Janni W, Novopashenny I, Ebner F, Kreienberg R, et al. Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival, and is there a role for guideline-adherent adjuvant therapy? A retrospective multicenter cohort study of 8,935 patients. Breast Cancer Res Treat. 2013;142(3):579–90.

    Article  CAS  PubMed  Google Scholar 

  38. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991;19(5):403–10.

    Article  CAS  PubMed  Google Scholar 

  39. Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, et al. Tailoring therapies-improving the management of early breast cancer: St Gallen international expert consensus on the primary therapy of early breast cancer 2015. Ann Oncol. 2015;26(8):1533–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Senkus E, Kyriakides S, Penault-Llorca F, Poortmans P, Thompson A, Zackrisson S, et al. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi7–23.

    Article  PubMed  Google Scholar 

  41. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. Arch Pathol Lab Med. 2014;138(2):241–56.

    Article  PubMed  Google Scholar 

  42. Allred DC, Harvey JM, Berardo M, Clark GM. Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Mod Pathol. 1998;11(2):155–68.

    CAS  PubMed  Google Scholar 

  43. Harvey JM, Clark GM, Osborne CK, Allred DC. Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer. J Clin Oncol. 1999;17(5):1474–81.

    Article  CAS  PubMed  Google Scholar 

  44. McCarty KS Jr, Miller LS, Cox EB, Konrath J, McCarty KS Sr. Estrogen receptor analyses. Correlation of biochemical and immunohistochemical methods using monoclonal antireceptor antibodies. Arch Pathol Lab Med. 1985;109(8):716–21.

    PubMed  Google Scholar 

  45. Penault-Llorca F, Vincent-Salomon A, MacGrogan G, Roger P, Treilleux I, Valent A, et al. 2014 update of the GEFPICS' recommendations for HER2 status determination in breast cancers in France. Ann Pathol. 2014;34(5):352–65.

    Article  PubMed  Google Scholar 

  46. Aurilio G, Disalvatore D, Pruneri G, Bagnardi V, Viale G, Curigliano G, et al. A meta-analysis of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases. Eur J Cancer. 2014;50(2):277–89.

    Article  CAS  PubMed  Google Scholar 

  47. Penault-Llorca F, Radosevic-Robin N. Biomarkers of residual disease after neoadjuvant therapy for breast cancer. Nat Rev Clin Oncol. 2016;13(8):487–503.

    Article  CAS  PubMed  Google Scholar 

  48. Penault-Llorca F, Coudry RA, Hanna WM, Osamura RY, Ruschoff J, Viale G. Experts' opinion: recommendations for retesting breast cancer metastases for HER2 and hormone receptor status. Breast. 2013;22(2):200–2.

    Article  PubMed  Google Scholar 

  49. Penault-Llorca F, Coeffic D, Delozier T, Dohollou N, Freyer G, Gligorov J, et al. Node negative breast cancer. Beyond international consensus: a pragmatic approach. Bull Cancer. 2011;98(7):807–25.

    PubMed  Google Scholar 

  50. Dowsett M, Nielsen TO, A'Hern R, Bartlett J, Coombes RC, Cuzick J, et al. Assessment of Ki67 in breast cancer: recommendations from the international Ki67 in breast cancer working group. J Natl Cancer Inst. 2011;103(22):1656–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Jonat W, Arnold N. Is the Ki-67 labelling index ready for clinical use? Ann Oncol. 2011;22(3):500–2.

    Article  CAS  PubMed  Google Scholar 

  52. Colleoni M, Rotmensz N, Maisonneuve P, Sonzogni A, Pruneri G, Casadio C, et al. Prognostic role of the extent of peritumoral vascular invasion in operable breast cancer. Ann Oncol. 2007;18(10):1632–40.

    Article  CAS  PubMed  Google Scholar 

  53. Harris LN, Ismaila N, McShane LM, Andre F, Collyar DE, Gonzalez-Angulo AM, et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34(10):1134–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 2016;23(12):3801–10.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Provenzano E, Bossuyt V, Viale G, Cameron D, Badve S, Denkert C, et al. Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group. Mod Pathol. 2015;28(9):1185–201.

    Article  PubMed  Google Scholar 

  56. Symmans WF, Peintinger F, Hatzis C, Rajan R, Kuerer H, Valero V, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol. 2007;25(28):4414–22.

    Article  PubMed  Google Scholar 

  57. Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001;98(19):10869–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Prat A, Ellis MJ, Perou CM. Practical implications of gene-expression-based assays for breast oncologists. Nat Rev Clin Oncol. 2012;9(1):48–57.

    Article  CAS  Google Scholar 

  59. Guiu S, Michiels S, Andre F, Cortes J, Denkert C, Di Leo A, et al. Molecular subclasses of breast cancer: how do we define them? The IMPAKT 2012 working group statement. Ann Oncol. 2012;23(12):2997–3006.

    Article  CAS  PubMed  Google Scholar 

  60. Prat A, Adamo B, Cheang MC, Anders CK, Carey LA, Perou CM. Molecular characterization of basal-like and non-basal-like triple-negative breast cancer. Oncologist. 2013;18(2):123–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Lehmann BD, Bauer JA, Chen X, Sanders ME, Chakravarthy AB, Shyr Y, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest. 2011;121(7):2750–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Masuda H, Baggerly KA, Wang Y, Zhang Y, Gonzalez-Angulo AM, Meric-Bernstam F, et al. Differential response to neoadjuvant chemotherapy among 7 triple-negative breast cancer molecular subtypes. Clin Cancer Res. 2013;19(19):5533–40.

    Article  CAS  PubMed  Google Scholar 

  63. Prat A, Parker JS, Karginova O, Fan C, Livasy C, Herschkowitz JI, et al. Phenotypic and molecular characterization of the claudin-low intrinsic subtype of breast cancer. Breast Cancer Res. 2010;12(5):R68.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Curtis C, Shah SP, Chin SF, Turashvili G, Rueda OM, Dunning MJ, et al. The genomic and transcriptomic architecture of 2,000 breast tumours reveals novel subgroups. Nature. 2012;486(7403):346–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Burstein MD, Tsimelzon A, Poage GM, Covington KR, Contreras A, Fuqua SA, et al. Comprehensive genomic analysis identifies novel subtypes and targets of triple-negative breast cancer. Clin Cancer Res. 2015;21(7):1688–98.

    Article  CAS  PubMed  Google Scholar 

  66. Pracella D, Bonin S, Barbazza R, Sapino A, Castellano I, Sulfaro S, et al. Are breast cancer molecular classes predictive of survival in patients with long follow-up? Dis Markers. 2013;35(6):595–605.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Wirapati P, Sotiriou C, Kunkel S, Farmer P, Pradervand S, Haibe-Kains B, et al. Meta-analysis of gene expression profiles in breast cancer: toward a unified understanding of breast cancer subtyping and prognosis signatures. Breast Cancer Res. 2008;10(4):R65.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Cardoso F, van't Veer LJ, Bogaerts J, Slaets L, Viale G, Delaloge S, et al. 70-Gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med. 2016;375(8):717–29.

    Article  CAS  PubMed  Google Scholar 

  69. Wolmark N, Mamounas EP, Baehner FL, Butler SM, Tang G, Jamshidian F, et al. Prognostic impact of the combination of recurrence score and quantitative estrogen receptor expression (ESR1) on predicting late distant recurrence risk in estrogen receptor-positive breast cancer after 5 years of Tamoxifen: results from NRG oncology/National Surgical Adjuvant Breast and bowel project B-28 and B-14. J Clin Oncol. 2016;34(20):2350–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Buus R, Sestak I, Kronenwett R, Denkert C, Dubsky P, Krappmann K, et al. Comparison of EndoPredict and EPclin with Oncotype DX recurrence score for prediction of risk of distant recurrence after endocrine therapy. J Natl Cancer Inst. 2016;108(11):djw149.

    Article  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, 58 rue Montalembert, BP 392, 63011, Clermont-Ferrand Cedex 1, France

    Frederique Penault-Llorca MD, PhD & Nina Radosevic-Robin MD

Authors
  1. Frederique Penault-Llorca MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nina Radosevic-Robin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederique Penault-Llorca MD, PhD .

Editor information

Editors and Affiliations

  1. The Medical School Department of Oncology, University of Sheffield, Sheffield, United Kingdom

    Lynda Wyld

  2. Athens University Medical School, Athens, Greece

    Christos Markopoulos

  3. Helsinki University Hospital, Helsinki, Finland

    Marjut Leidenius

  4. Department of Oncology & Radiotherapy, Gdańsk Medical University Department of Oncology & Radiotherapy, Gdańsk, Poland

    Elżbieta Senkus-Konefka

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Penault-Llorca, F., Radosevic-Robin, N. (2018). Pathology of Breast Cancer. In: Wyld, L., Markopoulos, C., Leidenius, M., Senkus-Konefka, E. (eds) Breast Cancer Management for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-319-56673-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56673-3_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56671-9

  • Online ISBN: 978-3-319-56673-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation