The importance of histological assessment after neoadjuvant therapy and the need for standardisation

Neoadjuvant therapy is increasingly being recognised as a management option for patients with primary invasive breast carcinoma; this may take the form of primary endocrine treatment or primary chemotherapy. Surgical specimens from women treated with neoadjuvant treatments, particularly primary chemotherapy, may cause a challenge for the histopathologist in handling and interpretation and have, in the past, been sampled, evaluated, and reported in a non-standardised way. This limits comparison between clinical trials and potentially provides clinicians and patients with suboptimal prognostic information. We describe here some of the difficulties faced and the recommendations and standards now applied.