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Wednesday, March 11, 2009 — 8:00 AM - 5:15 PM
Convention Center Auditorium
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COURSE DIRECTORS:
Stuart J. Schnitt, MD
Beth Israel Deaconess Medical Center
and Harvard Medical School
Boston, MA
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Frances P. O’Malley, MD
Mount Sinai Hospital and University of Toronto
Toronto, Ontario, Canada
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The aim of this course is to provide practicing pathologists and pathologists in training with a comprehensive update on many controversial areas of breast pathology through lectures given by experts on these subjects. The goal of each lecture is to review practical diagnostic and differential diagnostic issues and to emphasize the role of contemporary ancillary techniques where appropriate. The first half of the course will deal primarily with pre-invasive breast lesions including benign intraductal proliferative lesions, ductal carcinoma in situ and lobular neoplasia. The second half of the course will focus on the emerging role of molecular techniques in breast cancer classification and assessment of prognosis, hereditary breast cancer, controversies regarding assessment of hormone receptor and HER2 status, and core needle biopsy. Topics to be covered, and objectives for each speaker, are listed below.
AGENDA
| 8:00 | Introduction - Stuart J. Schnitt, M.D
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| 8:05 | Intraductal proliferative lesions: morphology, associated risk, and molecular biology - Ian O. Ellis, M.D., City Hospital, NHS Trust, Nottingham, UK
- To review the histologic criteria and terminology for usual ductal hyperplasia, atypical ductal
hyperplasia, flat epithelial atypia and ductal carcinoma in situ
- To provide an overview of the risk of breast cancer associated with these various lesions.
- To discuss established and emerging data on the molecular biology and pathogenesis of these lesions.
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| 8:45 | Ductal carcinoma in situ: pathologic features, differential diagnosis, prognostic factors, and specimen evaluation
Sarah E. Pinder, M.D., Kings College London/Guy’s and St Thomas’ Hospitals, London, United Kingdom
- To provide a review of the range of morphological features of ductal carcinoma in situ (DCIS)
- To discuss differential diagnosis of the spectrum, from low grade DCIS to microinvasive carcinoma
- To present the possible pitfalls in macroscopic assessment and specimen handling of cases of DCIS
- To outline those features which predict for recurrence of disease and prognostic factors
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| 9:20 | Questions
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| 9:30 | Coffee Break, Poster Session III, Exhibits
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| 11:00 | Lobular neoplasia: morphology, biologic potential and management in core biopsies - Frances P. O’Malley, M.D.
- To describe the morphologic criteria used to diagnose the spectrum of lobular neoplastic lesions including pleomorphic variant of lobular carcinoma in situ
- To discuss the data exploring the biologic potential of lobular neoplasia from an epidemiologic and molecular viewpoint
- To outline the recommendations for management of lobular neoplasia, particularly when encountered in core biopsies
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| 11:30 | Sentinel lymph node biopsy/Management issues for patients with carcinoma in situ - Donald Weaver, M.D., University of Vermont Medical School, Burlington, VT and
Barbara L. Smith, M.D., Ph.D., Massachusetts General Hospital and Harvard Medical School, Boston, MA
- To understand the prognostic continuum for nodal tumor burden
- To understand how sentinel node evaluation enhances identification of micrometastases
- To understand survival impact of micrometastases relative to macrometastases
- To understand limitations of pathologic analysis of sentinel nodes
- To discuss evaluation and sampling strategies for sentinel nodes
- To review current clinical management of in situ breast carcinomas including how specific aspects
of a pathology report are used in clinical decision-making
- To discuss the current role of sentinel node biopsy in management of invasive breast carcinomas and
ductal carcinoma in situ
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| 12:10 | Lunch |
| 1:30 | Core needle biopsy - Michael Bilous, MA, MBChB, FRCPA, Institute of Clinical Pathology and Medical Research, Westmeade Hospital, NSW, Australia
- To discuss the role of core needle biopsy (CNB) in the management of breast disease
- To outline methods of handling and reporting of CNB including for patients undergoing neoadjuvant
therapy for breast cancer
- To discuss problematic lesions sampled by CNB and for which the need for excision is unclear
- To discuss post-CNB complications and artefacts
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| 2:00 | Hereditary breast cancer - Sunil R. Lakhani, M.D., School of Medicine, University of Queensland, Mayne Medical School, Herston, Queensland, Australia
- To present the morphological, immunohistochemical and molecular features of hereditary breast cancers
- To illustrate how the pathology data may be used to aid clinical decision making in selecting patients
for germline testing
- To discuss new avenues for treating hereditary breast cancer
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| 2:30 | Questions |
| 2:40 | Coffee Break, Poster Session IV, Exhibits |
| 4:00 | Update on estrogen receptor, progesterone receptor, and HER2 Testing
D. Craig Allred, M.D., Washington University School of Medicine, St. Louis, MO
- To discuss the history of ER, PR, and HER2 testing in breast cancer.
- To discuss general guidelines for assessing prognostic/predictive factors, emphasizing technical and
clinical validation.
- To discuss the current clinical utilization of ER, PR, and HER2 testing in breast cancer.
- To discuss ER and PR testing by immunohistochemistry (IHC).
- To discuss HER2 testing by IHC and fluorescent in situ hybridization (FISH).
- To discuss new national guidelines for HER2 testing and impending guidelines for ER and PR testing.
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| 4:30 | Classification and prognosis of invasive breast cancer: from morphology to molecular taxonomy - Stuart J. Schnitt, M.D., Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
- To review the impact of newer molecular techniques on the classification of breast cancers
- To review the role of immunohistochemical markers as surrogates for gene expression profiling for the
molecular taxonomy of breast cancers
- To discuss the role of molecular tests for assessing prognosis in patients with breast cancer
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| 5:00 | Questions and Closing Remarks
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