Changes Related to Breast Surgery and Neoadjuvant Therapy

In order to interpret imaging findings or pathologic abnormality with accuracy, it is paramount to know the patient’s history of prior surgery, the reason for surgery and the interval between prior surgery and the current abnormality, as postsurgical scar can mimic new invasive carcinoma or recurrent carcinoma. It is important for pathologists to be familiar with the type of initial carcinoma before classifying the ipsilateral tumor as recurrent vs. new primary. Similarly, any follow-up imaging studies performed after a patient’s initial diagnosis of invasive carcinoma should prompt the radiologist to review the pretreatment imaging findings, the history of neoadjuvant systemic therapy and the type of neoadjuvant therapy (chemotherapy, endocrine therapy, or radiation therapy). Pathologic examination of post-treated breast carcinomas is challenging and requires a detailed history, response to therapy based on clinical or imaging findings (both pretreatment and follow-up imaging results). Comparison of pretreatment tumor biopsy with post-treated residual tumor is valuable and should be performed when possible.