The problems in the management of pre-invasive and invasive breast lesions have been highlighted in the scientific media and more recently in the popular press. The need for a refresher course in dealing with diagnostic issues has been highlighted in several of these articles. This course addresses critical issues that impact surgical pathologists as well as those of the lives of women being treated for their breast disease. With the goal of addressing diagnostic issues, our aim is to discuss pre-invasive lesions, especially DCIS, and the assessment of histological parameters that guide the therapeutic decisions for patients with invasive disease, including immunohistochemistry for predictive markers, sentinel node biopsy reporting, and molecular taxonomy. The course is directed at an audience that includes pathologists at all stages from early residents to advanced practitioners and will provide the participants up to date information and current opinions on management of common dilemmas in breast pathology including an overview of the ASCO-CAP guidelines. Lesions to be discussed include the differential diagnoses of DCIS, papillary lesions and luminal and triple negative tumors. The presenters will also address examination of sentinel lymph nodes.

Upon completion of this educational activity, participants should be able to: 1) Distinguish DCIS from ADH and FEA and compare management and medico-legal issues surrounding this differential diagnosis; 2) Identify pitfalls in the diagnosis of papillary lesions of the breast, the role for special stains in making the diagnosis and treatment options; 3) Apply ASCO-CAP guidelines for ER/PR/HER2 testing; 4) Handle and interpret sentinel lymph node biopsies based upon data from clinical trials; 5) Discuss the role of molecular testing in estrogen receptor positive tumors; and 6) Explain the associations between triple negative breast cancers and heredity, the role of basal markers in making the diagnosis, treatment options for these tumors, and the role of PARP inhibition and other prognostic tests for triple negative tumors.

Virtual images and clinical histories will be posted on the USCAP website for review by pre-registrants prior to the meeting. A syllabus will be distributed to registrants at the meeting. After the meeting, participants will receive web access to the PowerPoint presentations given during the USCAP Annual Meeting along with the text portion of the syllabus.