The impact of an erroneous diagnosis on core needle biopsy of the breast is much greater in contemporary practice; both because of a shift to de-escalating the need for excision of benign and high-risk lesions, and because of the use of neoadjuvant chemotherapy following a diagnosis of invasive carcinoma.
This session will cover how best to differentiate common and uncommonly encountered diagnostic challenges in breast tumor pathology, particularly as they pertain to breast CNB specimens; how to anticipate pitfalls and mitigate mistakes through recognition of morphologic clues and ancillary testing strategies that can support diagnostic interpretation, and help prevent errors.

Molecular and multigene testing has been incorporated in breast cancer management pathways. Multigene tests such as OncotypeDx, Prosigna and EndoPredict have been licenced by NICE in the intermediate risk group to assess for the risk of recurrence (prognosis). High risk tumours receive adjuvant chemotherapy. The Oncotype DX also predicts benefit from adjuvant chemotherapy.
Low resource countries may struggle with access to those tests. Several morphological parameter, such as tumour grade and lymph node status and immunohistochemical markers, such as Ki-67 ian be used as alternatives. In addition, artificial intelligence (AI) algorithms have recently been developed to derive important prognostic information by analysing routine H&E slides.