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Predictive Diagnostic Pathology in the Target Therapy Era in Breast Cancer
Caterina Marchio, Davide Balmativola, Roberta Castiglione
1Department of Medical Sciences, University of Turin, via Santena 7, 10126, Turin, Italy.
Abstract:
Treatment strategies in oncology are nowadays largely based on the "target therapy model", which allows to personalize the cure of each patient depending on distinctive host and disease features. As a general concept "targeted drugs" are effective only when the tumor exhibits the "target", which in breast cancer pathology may correspond to the expression of estrogen receptors and/or of HER2. These biomarkers are evaluated on breast cancer tissues by companion diagnostic tests, however, evidence suggests that the first step in breast cancer predictive pathology is still represented by morphology. For instance, histological types, such as tubular and cribriform carcinomas, define patients who may not need any treatments other than surgical excision. Neoadjuvant studies have shown that patients affected by lobular carcinomas are not likely to have any beneficial effects from chemotherapy. The second step in prediction is represented by immunophenotyping. If the immunohistochemical evaluation of four markers (estrogen and progesterone receptors, HER2 and Ki67) remains the best practice for breast cancer predictive pathology, molecular pathology has certainly reshaped the way we approach breast cancer diagnosis. The aim of this review is to discuss current knowledge in predictive pathology for the management of breast cancer patients, focusing on the benefits and drawbacks of traditional tools and of novel improvements of molecular biology.
Insights
Predictive pathology in breast cancer management combines morphology and immunophenotyping with emerging molecular techniques. Understanding these tools optimizes targeted therapy and patient treatment strategies for better outcomes.
Area of Science:
- Oncology
- Pathology
- Molecular Biology
Background:
- Current oncology treatment relies on the target therapy model for personalized patient care.
- Targeted drug efficacy in breast cancer depends on tumor biomarkers like estrogen receptors and HER2.
- Companion diagnostic tests evaluate these biomarkers, but morphology remains a crucial initial predictive step.
Purpose of the Study:
- To review current knowledge in predictive pathology for breast cancer patient management.
- To discuss the benefits and drawbacks of traditional diagnostic tools.
- To explore novel advancements in molecular biology for breast cancer diagnosis and treatment.
Main Methods:
- Morphological assessment of histological types (e.g., tubular, cribriform carcinomas) for treatment decisions.
- Immunophenotyping, including immunohistochemical evaluation of four key markers (estrogen receptors, progesterone receptors, HER2, Ki67).
- Integration of molecular pathology techniques to refine breast cancer diagnosis and treatment strategies.
Main Results:
- Specific histological types may indicate the need for surgical excision only.
- Lobular carcinomas show limited benefit from chemotherapy in neoadjuvant settings.
- Immunohistochemistry for four markers is standard, but molecular pathology is transforming diagnostic approaches.
Conclusions:
- Predictive pathology, encompassing morphology, immunophenotyping, and molecular diagnostics, is essential for personalized breast cancer treatment.
- Morphology and immunophenotyping provide foundational predictive information.
- Molecular pathology offers advanced insights, reshaping breast cancer management and targeted therapy selection.
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