Preoperative assessment of prognostic factors in breast cancer

The adoption of preoperative diagnostic strategies involving fine needle as piration cytology (FNAC) or core biopsy is well established, allowing the p lanning of operating lists and bed occupancy and patient involvement in the rapeutic management. In addition to diagnosis, however, pathologists are in creasingly being asked to provide pathological prognostic information from preoperative samples. This leader describes techniques for predicting progn osis and response to treatment on these specimens and some of the problems inherent in the determination of prognosis on small samples. For example, a lthough histological grade can be assessed relatively reliably on either co re or FNAC samples, the evaluation of tumour type (which includes an overal l assessment of the architecture of a given tumour) may be less reliable on small preoperative samples. Other well recognised histological prognostic factors, such as vascular channel invasion or tumour size, cannot be determ ined accurately on small preoperative samples. For those patients who might benefit from neoadjuvant treatment, predicting the response to such treatm ents-for example, by the assessment of oestrogen receptor status-can readil y be performed on either core biopsy or FNAC. In the future, other molecula r markers such as C-erbB-2 might also prove beneficial in predicting respon se to newly developed treatments.