Evaluation And Comparison Of Various Histopathological Assessment Systems In Breast Carcinoma Patients After Neoadjuvant Chemotherapy

Abstract

newline ABSTRACT newlineBackground: Breast carcinoma remains the most common malignancy among women worldwide, with a substantial proportion of patients in India presenting at a locally advanced stage. Neoadjuvant chemotherapy (NACT) has emerged as a standard therapeutic approach in such cases, offering tumour downstaging, increased breast conservation rates, and early assessment of chemosensitivity. Accurate histopathological evaluation of post-NACT specimens is critical for prognostication and therapeutic decision-making. However, multiple histopathological response assessment systems are currently in use, including Miller Payne, Residual Cancer Burden (RCB), AJCC ypTNM, Sataloff, Chevallier, Pinder, and NSABP B-18 systems, with no universal consensus regarding the most reliable and practical method. newlineAim: To evaluate and compare various histopathological assessment systems used for determining tumor response in breast carcinoma patients treated with neoadjuvant chemotherapy and to identify the system with the best prognostic performance and clinical applicability. newlineObjectives: newline1. To assess histopathological response to NACT using established grading systems. newline2. To correlate pathological response categories with clinicopathological and biomolecular parameters. newline3. To compare the prognostic accuracy and reproducibility of existing response assessment systems. newline4. To evaluate the performance of a proposed integrated reporting approach for post-NACT specimens. newlineMaterials and Methods: This observational study included breast carcinoma patients who received NACT followed by surgical resection. Pre-treatment core biopsy and post-NACT surgical specimens were evaluated histopathologically. Multiple response assessment systems Miller Payne, RCB, AJCC ypTNM, Sataloff, Chevallier, Pinder, and NSABP B-18 were applied to the same cohort. Clinicopathological variables including tumor size, histological type, grade, lymphovascular invasion, nodal status, and ER/PR/HER2 status were analyzed. Statistical analysis included chi-square