Breast pathology poses a particular diagnostic challenge due to the broad spectrum of functional, reactive and neoplastic changes in the breast. Objectifiable and reproducible criteria are the key to a valid diagnosis. In addition to the diagnostic classification of lesions, it is the task of pathologists to identify and document all tumor characteristics that are relevant for clinical management. Modern personalized medicine is based on up-to-date, valid pathomorphological and molecular diagnostics. Reports of findings should be written comprehensibly, completely and quickly. Structured pathology reports are ideal for this purpose. Before artificial intelligence can fulfil the hopes placed in it regarding the acceleration and objectification of reporting, technical and financial limitations must be resolved in addition to the explainability of AI-generated decisions.

Breast cancer is the most common malignancy in women, being responsible for more than half a million deaths every year. As such, early and accurate diagnosis is of paramount importance. Human expertise is required to diagnose and correctly classify breast cancer and define appropriate therapy, which depends on the evaluation of the expression of different biomarkers such as the transmembrane protein receptor HER2. This evaluation requires several steps, including special techniques such as immunohistochemistry or in situ hybridization to assess HER2 status. With the goal of reducing the number of steps and human bias in diagnosis, the HEROHE Challenge was organized, as a parallel event of the 16th European Congress on Digital Pathology, aiming to automate the assessment of the HER2 status based only on hematoxylin and eosin stained tissue sample of invasive breast cancer. Methods to assess HER2 status were presented by 21 teams worldwide and the results achieved by some of the proposed methods open potential perspectives to advance the state-of-the-art.

Telemedizin, definiert als ärztliche Leistungserbringung über räumliche oder zeitliche Distanz hinweg und unter Einsatz moderner Informations- und Kommunikationstechnologien, gewinnt auch in der Versorgung von Krebspatienten an Bedeutung. Die onkologische Versorgung in Deutschland wird maßgeblich von den zertifizierten Zentren der Deutschen Krebsgesellschaft geprägt. Die Zentren erfüllen hohe Qualitätsanforderungen, beispielsweise mit Blick auf die fachliche Expertise und interdisziplinäre Zusammenarbeit. Der so bestehende große Kommunikationsbedarf eröffnet potenzielle Einsatzfelder für die Telemedizin. Anhand der Beispiele Tele-Tumorkonferenz und Telepathologie beschreibt dieser Beitrag Chancen und Risiken bei der Implementierung von Telemedizin in der Onkologie: Sie ermöglicht den Leistungserbringern eine effizientere Zusammenarbeit und die flächendeckende Einbringung onkologischen Wissens. Andererseits besteht je nach Einsatzbereich und Umsetzung die Gefahr von Informationsverlusten oder Einbußen für den Versorgungsstandard. Diese Aspekte gilt es kritisch abzuwägen, damit die Telemedizin die Onkologie positiv weiterentwickelt und gleichzeitig die Qualität der Patientenversorgung erhalten bleibt.

Accurate determination of the predictive markers human epidermal growth factor receptor 2 (HER2/ERBB2), estrogen receptor (ER/ESR1), progesterone receptor (PgR/PGR), and marker of proliferation Ki67 (MKI67) is indispensable for therapeutic decision making in early breast cancer. In this multicenter prospective study, we addressed the issue of inter- and intrasite reproducibility using the recently developed reverse transcription-quantitative real-time polymerase chain reaction-based MammaTyper® test.

Purpose Core needle biopsies (CNBs) are widely used to determine human epidermal growth factor receptor 2 (HER2) status in breast cancer. Recent publications reported up to 20% false-positive results on CNBs if immunohistochemistry (IHC) is compared with fluorescent in situ hybridization (FISH). To clarify, if confirmation of IHC positivity by FISH is generally required, we analyzed the reliability of IHC positivity on CNBs versus surgical specimens in a multi-institutional study.Patients and Methods Five pathologic laboratories contributed to this study by performing IHC on 500 CNBs and the corresponding surgical specimens overall. If IHC revealed score 2+ or 3+, HER2 status was confirmed by FISH in a central laboratory. We compared evaluation according to US Food and Drug Administration-approved scoring criteria and recently published American Society of Clinical Oncology (ASCO)-College of American Pathologists (CAP) guidelines.Results CNBs scored 3+ revealed five false-positive results if scoring followed the US Food and Drug Administration criteria (five of 40; 12.5%) and two false-positives in terms of the ASCO-CAP criteria (two of 33; 6.1%). IHC was false negative in one CNB only. By contrast, IHC on surgical specimens revealed five false-negative results, but only one false-positive result (one of 35; 2.9%) if scored following US Food and Drug Administration-approved criteria. With the aid of the ASCO-CAP criteria, false-positive IHC results were obtained in only one of the five participating institutions.Conclusion IHC 3+ scores on CNBs proved to be reliable in four of the five participating institutions if scoring followed the ASCO-CAP criteria. Therefore, accurate determination of HER2 status in breast cancer is possible on CNB using the common strategy to screen all cases by IHC and retest only 2+ scores by FISH. Prerequisites are quality assurance and the application of the new ASCO-CAP criteria.