Histopathological Changes in Breast Cancers Following Neoadjuvant Chemotherapy: Implications for Assessment of Therapy-Induced Cytological and Stromal Changes for Better Clinical Outcome and Effective Patient care

Abstract

The histopathological interpretation of a tumor still remains the gold standard for diagnosis and deciding the type of therapy. Furthermore, in the context of chemo-radio-therapies often leading to prominent cytological and stromal changes in the tumor, histopathological interpretation during treatment, thus, becomes all the more important in correctly diagnosing and grading the tumor for an effective and planned regimen of the therapy increasing prognosis and chances of survival of the affected patients. The aim of the present study was to evaluate such cytological and stromal changes rendered by the therapy during treatment in breast cancer cases. The present study was conducted over a period of 4 years from January 2014 to June 2017 at Kasturba Medical College, Mangalore, Karnataka, India wherein the clinical and histopathological details were collected for a total of 39 breast carcinoma cases during and post-therapy. Statistical analysis was done using IBM SPSS statistics 17 (Chicago, USA). Various morphological features were analyzed for their frequency and were compared with the final diagnosis using Chi-square value (χ2), paired t-test and Fischer's test. p-value < 0.05 was considered to be statistically significant. The results of the present study revealed that 32 of the 39 breast carcinoma cases changed their grades during the course of therapy (p-value < 0.05). The fundamental manifestation of the effect of therapy was an obvious decrease in tumor cellularity. Intracellular changes commonly noted after chemotherapy included nuclear enlargement, hyperchromasia and an increased N:C ratio which were found in upto 85% of the cases followed by presence of prominent nucleoli and karyorrhexis/karyolysis. The predominant stromal changes seen post-therapy included necrosis (74.4%), fibrosis (64.1%), desmoplasia (59%) and degenerative changes (33.3%). Breast cancer therapy causes morphological alterations in the cancerous as well as the surrounding healthy tissue. The histopathological interpretation in such cases, thus, requires a thorough knowledge of the cytological and stromal changes rendered by the therapy.

Keywords

• therapy-induced histopathological changes
• breast cancers
• neoadjuvant chemotherapy
• breast cancer diagnosis and treatment