After neoadjuvant treatment the residual cancer may be microscopic or absent, and a complete response can only be called if the whole tumour bed has been examined. Ask for the pre-treatment size and the position of any clip, and use specimen radiography to find it. Identify the tumour bed grossly as a firm, pale or fibrotic area, measure it in three dimensions, and map the sections so that any residual focus can be located and measured. Sample nodes thoroughly and look for treatment effect as well as tumour.
- Get the pre-treatment tumour size and clip location before grossing
- Use specimen radiography to locate the clip
- Measure the tumour bed in three dimensions and map the sections
- Look for treatment effect in nodes as well as residual tumour
Why it matters
An under-sampled tumour bed can turn residual disease into a false complete response.
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