Sunil Badve, M.D,. FRCPath, Indiana University, Indianapolis, IN and David Hicks, M.D., Roswell Park Cancer Institute, Buffalo, NY
Diagnosis and treatment of breast diseases present crucial issues for both the pathologist and clinician. It is important to establish a dialogue between the clinic and the lab in order to provide quality health care. This dialogue is often centered on the assessment of histopathological grade of the tumor and the expression of tumor markers. The latter is no longer limited to the expression of estrogen and progesterone receptors. This course is intended to introduce and familiarize the audience with newer methods involved in the prognostication of breast cancer.
The course will focus on the following: 1) Hereditary breast cancer including genes involved, genetic testing and its interpretation, and morphological parameters associated with hereditary breast cancer and their use in selecting patients for genetic analysis; 2) Novel methods of breast cancer classification including luminal, Her-2 and basal phenotypes, their limitations, and relevance for therapy; 3) Her-2 expression including methodologies associated with HER2 testing, interlaboratory variability, interaction with other parameters such as ER/PR, impact of anti-her-2 (transtuzumab or Herceptin and C225) therapy and factors associated with de novo or acquired resistance to this therapy. Other members of the EGFR family will also be discussed briefly; 4) Angiogenesis and anti-angiogenic therapy including bevacuzumab (Avastin) and small molecular inhibitors of angiogenesis; 5) Molecular methods for prognostication including RT-PCR analysis techniques used on fresh (Mammoprint ® or paraffinized tissues (Oncotype DX® and the MGH 2-gene score). In addition the value and methods associated with assessment of circulating tumor cells (CTCs) will be discussed; 6) Therapy related changes associated with pre-op chemotherapy will be presented and issues related to adequacy of specimen evaluation, validity of sentinel node biopsy, definition of complete pathologic response and residual diseases highlighted. A CD with case histories and images will be available for advance mailing. A handout will be distributed at the course, and after the meeting all participants will be mailed a CD of representative case material. (New Course)