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Role of pathology in the management of advanced breast cancer Beppe Viale European Institute of Oncology University of Milan Milan, Italy
The role of the pathologist ,[object Object],[object Object],[object Object],[object Object],[object Object]
The role of the pathologist ,[object Object],[object Object],[object Object]
Second primaries
The role of the pathologist ,[object Object],[object Object],[object Object],[object Object],[object Object]
Carcinoma of unknown primary ,[object Object],[object Object],[object Object],[object Object]
CUP sites ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A biopsy will tell us where it is coming from (!) ,[object Object],[object Object],[object Object],[object Object]
…   but not always! ,[object Object],[object Object],[object Object]
Metastasis from a second primary
Metastasis from a second primary
ER Breast carcinoma metastatic to bone
ER Breast carcinoma metastatic to the stomach
The role of the pathologist ,[object Object],[object Object],[object Object],[object Object],[object Object]
Do tumors change? ,[object Object],[object Object]
Why do tumours change? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intratumoral heterogeneity
…  also in the metastases
 
Why do tumours change? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1250 liver biopsies from 1999-2009; 255 identified as BC metastases
But our assays are not “perfect” ,[object Object],[object Object],[object Object]
Real status  - unknown!- (N) ER- (200) ER+ (800) 190 Sensitivity p +  =  0.95 Tumor N 10 40 760 180 Metastasis N 10 9 1 2 38 38 722 Specificity p -  =  0.95 Changed status from T to M 95/1000 = 9.5% + p +  = 0.95 p -  = 0.05 p +  = 0.95 p -  = 0.05 p +  = 0.95 p -  = 0.05 p -  = 0.95 p +  = 0.05 p +  = 0.05 p +  = 0.05 - + + - - + - - + - + p -  = 0.95 p -  = 0.95 Do tumours change?
What to do? ,[object Object],[object Object],[object Object],[object Object],[object Object]
If discordance is confirmed ,[object Object],[object Object],[object Object]
 
 
Il sugo di tutta la storia (A. Manzoni, I Promessi Sposi) ,[object Object],[object Object],[object Object],[object Object],Be nice to your fellow pathologists!

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Notas do Editor

  1. Gong Y, et al: Comparison of HER-2 status determined by fluorescence in situ hybridization in primary and metastatic breast carcinoma. Cancer. 2005 May 1;103(9):1763-9. Simon R, et al: Patterns of her-2/neu amplification and overexpression in primary and metastatic breast cancer. J Natl Cancer Inst. 2001 Aug 1;93(15):1141-6. Gancberg D, et al: Comparison of HER-2 status between primary breast cancer and corresponding distant metastatic sites. Ann Oncol. 2002 Jul;13(7):1036-43. Zidan J, et al: Comparison of HER-2 overexpression in primary breast cancer and metastatic sites and its effect on biological targeting therapy of metastatic disease. Br J Cancer. 2005 Sep 5;93(5):552-6.