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

Area of Science:

• Oncology
• Pathology
• Genomics

Background:

• The pathologist's role in breast cancer management has expanded beyond diagnosis.
• Prognostic and predictive parameters are essential for personalized treatment strategies.

Purpose of the Study:

• To review the latest prognostic and predictive parameters in breast cancer.
• To highlight their relevance in pathology reporting and clinical decision-making.

Main Methods:

• Review of current literature on breast cancer biomarkers.
• Analysis of established and emerging prognostic and predictive factors.
• Integration of genomic and histopathologic data.

Main Results:

• Estrogen Receptor (ER), HER2 status, and traditional parameters (histologic subtype, size, grade) remain vital.
• Gene-expression panels, like the 21-gene Recurrence Score, predict chemotherapy benefit in ER-positive, HER2-negative disease.
• Tumor-infiltrating lymphocytes (TILs) and response to neoadjuvant therapy are key in ER-negative subtypes.
• Germline BRCA, PIK3CA, and PD-L1 status guide treatment in metastatic breast cancer.

Conclusions:

• Pathology reporting increasingly incorporates advanced markers for tailored breast cancer treatment.
• These parameters enable precise patient stratification and selection for targeted therapies.
• The evolution of pathology supports individualized care pathways in all stages of breast cancer.