During the past 20 years, we have witnessed unprecedentedly fast developments in breast pathology and management of breast diseases, including but not limited to the molecular classification of breast cancer and multigene profiling assays and personalized therapies for patients with breast cancer, as well as the management of high-risk lesions diagnosed on core needle biopsies with a greater emphasis on radiologic-pathologic correlation. In addition, the emergence of artificial intelligence (AI) in pathology has created tremendous opportunities for improving diagnostic accuracy and development of prognostic and predictive biomarkers in breast cancer. In view of the Archives’ mission to represent the interests of the public, patients, and pathologists by helping laboratorians keep current with the quickly evolving field of breast pathology, we believe it is of utmost importance for pathologists to have access to the up-to-date, intelligible, and evidence-based data necessary to their successful practice.
In this special section, we compiled a series of 5 review articles (Part I and Part II) written by the thought leaders in this complex field. In the first article, Yueping Liu, MD, and colleagues provide an updated review of AI in breast pathology. They discuss current challenges and the potential use of AI in diagnosing and grading breast carcinomas, identifying metastatic carcinoma in axillary lymph nodes, quantitatively assessing breast cancer biomarkers to predict prognosis and response to therapy, and even predicting potential molecular changes within the neoplastic cells. Liu and colleagues emphasize that AI has tremendous potential to improve the accuracy of histopathologic diagnosis, reduce pathologists’ daily workload, and provide valuable prognostic and predictive information. The second article, by Edward T. Richardson, MD, PhD, and colleagues, examines recent advances in understanding the pathogenesis and novel diagnostic tools of salivary gland–like carcinomas of the breast, a subtype of triple-negative breast cancer characterized by a more favorable prognosis than most triple-negative carcinomas. They describe the clinical, histologic, immunophenotypic, and molecular features of these tumors in comparison with their salivary gland counterparts and also explore benign salivary gland–like tumors of the breast. The third article by Liza M. Quintana, MD, and Laura C. Collins, MD, is on diagnostic pitfalls in breast pathology with an emphasis on core biopsies. The authors discuss the pitfalls in diagnosing benign and malignant lesions in core biopsies and provide morphologic clues and guidance to the appropriate use and interpretation of immunohistochemical markers.
Beginning Part II of this special section, Qinqing Ding, MD, PhD, and colleagues provide an overview of common applications of immunohistochemical (IHC) stains for diagnosing invasive and noninvasive breast lesions, including benign and malignant spindle cell lesions. They discuss the strengths and limitations of IHC stains and provide evidence and their experiences in using these IHC stains to render accurate diagnoses of these lesions. The final article in the special section, by Gulisa Turashvili, MD, PhD, and Xiaoxian Li, MD, PhD, provides a comprehensive overview of inflammatory lesions of the breast with etiopathogenesis, clinical, radiologic, and pathologic features focusing on a practical approach for differential diagnosis, treatment, and prognosis. They emphasize that pathologists have a unique opportunity to play an essential role in patient management when accurately diagnosing clinically significant entities, such as cystic neutrophilic granulomatous mastitis, immunoglobulin G4 mastitis, or squamous metaplasia of lactiferous ducts.
We hope the readers will enjoy this collection of review articles discussing some of the important and updated topics in neoplastic and nonneoplastic breast pathology. The information presented herein will be helpful to a large audience, including practicing pathologists, pathology trainees, breast imagers, oncologists, and surgeons, as well as physicians from other specialties.
We sincerely thank Archives of Pathology & Laboratory Medicine Editor in Chief Alain C. Borczuk, and Managing Editor Katie Giesen for providing the opportunity for and the outstanding support during the publication of these articles.
Xiaoxian Li, MD, PhD
Xiaoxian (Bill) Li is a professor of pathology, director of breast pathology, director of immunohistochemistry laboratory, and codirector of anatomic pathology research at Emory University, Atlanta, Georgia. Li obtained his medical degree from Beijing Medical University (Beijing, China) and a PhD from The University of Maryland (College Park). Li completed his anatomic pathology/clinical pathology (AP/CP) residency training at The Methodist Hospital (Houston, Texas) and an oncologic pathology fellowship and a breast pathology fellowship at the MD Anderson Cancer Center (Houston, Texas). Li was inducted into the Emory University MilliPub Club twice for 2 of his seminal first-author papers in the field of breast cancer, which have been cited more than 1300 and more than 1000 times, respectively, per Web of Science. Li has more than 80 peer-reviewed publications, review articles, and several book chapters. Li is a principal investigator (PI) or co-PI of 6 active institutional, National Institutes of Health (NIH), Department of Defense (DOD), foundation, and industrial grants, and is the Emory PI of a newly awarded R01 grant that received a study section score in the top 1st percentile. The current research interests of Li’s laboratory are focused on developing biomarkers to predict breast cancer risk, prognosis, and response to therapies.
In 2015 Li initiated and has since been cochairing the monthly breast high-risk lesion conference at Emory, which has prevented unnecessary surgery for hundreds of patients. He has also served on the Emory University School of Medicine Faculty Committee on Appointment and Promotions (FCAP), the Emory Winship Breast Center Strategic Plan Steering Committee, the Emory Pathology Departmental FCAP Committee, the Faculty Mentoring Committee, the Incentive Plan Committee, the Workload in AP Task Force Committee, and the Digital Pathology Steering Committee. Li is the current cochair of the Faculty Affair Committee of the Emory School of Medicine Asian American and Pacific Islander (AAPI) Medical Faculty Association Affinity Group. At the national level, Li is a standing member of an American Cancer Society Grant Review Committee, and he is an ad hoc grant reviewer for the NIH, National Cancer Institute, DOD, and Breast Cancer Now, England. Li has been the lead pathologist of multiple national clinical trials in breast cancer. He currently serves on multiple national committees, including committees of the College of American Pathologists (CAP), the CAP Foundation, US Food and Drug Administration, the International Society of Breast Pathology, and the I-SPY2 Trial Pathology Working Group. Li has mentored numerous PhD students, residents, fellows, and visiting scholars and has been invited frequently to give lectures at national/international conferences, including the CAP and United States and Canadian Academy of Pathology annual meetings. Li serves as a section editor in breast pathology for the Archives of Pathology & Laboratory Medicine as well as on the editorial boards of other peer-reviewed scientific journals.
Xiaoxian Li, MD, PhD
Xiaoxian (Bill) Li is a professor of pathology, director of breast pathology, director of immunohistochemistry laboratory, and codirector of anatomic pathology research at Emory University, Atlanta, Georgia. Li obtained his medical degree from Beijing Medical University (Beijing, China) and a PhD from The University of Maryland (College Park). Li completed his anatomic pathology/clinical pathology (AP/CP) residency training at The Methodist Hospital (Houston, Texas) and an oncologic pathology fellowship and a breast pathology fellowship at the MD Anderson Cancer Center (Houston, Texas). Li was inducted into the Emory University MilliPub Club twice for 2 of his seminal first-author papers in the field of breast cancer, which have been cited more than 1300 and more than 1000 times, respectively, per Web of Science. Li has more than 80 peer-reviewed publications, review articles, and several book chapters. Li is a principal investigator (PI) or co-PI of 6 active institutional, National Institutes of Health (NIH), Department of Defense (DOD), foundation, and industrial grants, and is the Emory PI of a newly awarded R01 grant that received a study section score in the top 1st percentile. The current research interests of Li’s laboratory are focused on developing biomarkers to predict breast cancer risk, prognosis, and response to therapies.
In 2015 Li initiated and has since been cochairing the monthly breast high-risk lesion conference at Emory, which has prevented unnecessary surgery for hundreds of patients. He has also served on the Emory University School of Medicine Faculty Committee on Appointment and Promotions (FCAP), the Emory Winship Breast Center Strategic Plan Steering Committee, the Emory Pathology Departmental FCAP Committee, the Faculty Mentoring Committee, the Incentive Plan Committee, the Workload in AP Task Force Committee, and the Digital Pathology Steering Committee. Li is the current cochair of the Faculty Affair Committee of the Emory School of Medicine Asian American and Pacific Islander (AAPI) Medical Faculty Association Affinity Group. At the national level, Li is a standing member of an American Cancer Society Grant Review Committee, and he is an ad hoc grant reviewer for the NIH, National Cancer Institute, DOD, and Breast Cancer Now, England. Li has been the lead pathologist of multiple national clinical trials in breast cancer. He currently serves on multiple national committees, including committees of the College of American Pathologists (CAP), the CAP Foundation, US Food and Drug Administration, the International Society of Breast Pathology, and the I-SPY2 Trial Pathology Working Group. Li has mentored numerous PhD students, residents, fellows, and visiting scholars and has been invited frequently to give lectures at national/international conferences, including the CAP and United States and Canadian Academy of Pathology annual meetings. Li serves as a section editor in breast pathology for the Archives of Pathology & Laboratory Medicine as well as on the editorial boards of other peer-reviewed scientific journals.
Gulisa Turashvili, MD, PhD
Gulisa Turashvili, MD, PhD, is a board-certified academic anatomic pathologist specializing in breast and gynecologic pathology. She is currently an associate professor of pathology (effective September 2023), director of surgical pathology fellowship, and gynecologic pathology rotation director at Emory University. She earned her medical degree from Tbilisi State Medical University (Tbilisi, Georgia), and a PhD degree from Palacky University (Olomouc, Czech Republic), in collaboration with the CRC Institute for Cancer Studies, University of Birmingham Medical School (Birmingham, United Kingdom). Her pathology training included an anatomic pathology residency at Queen’s University (Kingston, Ontario, Canada), and gynecologic and breast pathology fellowships at Memorial Sloan Kettering Cancer Center (New York, New York). Before her residency training, Turashvili completed a Canadian Institutes of Health Research Fellowship at the British Columbia Cancer Research Center (Vancouver, British Columbia, Canada), where she was involved in the landmark METABRIC (Molecular Taxonomy of Breast Cancer International Consortium) study.
Turashvili has coauthored more than 100 peer-reviewed publications and book chapters. She serves on multiple national and international committees, including the Abstract Review Committee and Membership Committee of the United States and Canadian Academy of Pathology, the CheckPath Anatomic Pathology Committee of the American Society for Clinical Pathology, the NeoSTEEP Working Group of the National Cancer Institute and the Breast Cancer Surveillance Consortium (NCI-BCSC), the Malignant Germ Cell International Consortium (MaGIC), and the Pathology Work Group of International Gynecologic Cancer Society. She is the deputy editor of gynecologic pathology at PathologyOutlines and serves on the editorial boards of peer-reviewed scientific journals. In 2022, Turashvili was inducted into the Emory University MilliPub Club, which honors current Emory faculty who have publications that have each garnered more than 1000 citations. She also received a 2022 Emory School of Medicine Researcher Appreciation Day Recognition.
Gulisa Turashvili, MD, PhD
Gulisa Turashvili, MD, PhD, is a board-certified academic anatomic pathologist specializing in breast and gynecologic pathology. She is currently an associate professor of pathology (effective September 2023), director of surgical pathology fellowship, and gynecologic pathology rotation director at Emory University. She earned her medical degree from Tbilisi State Medical University (Tbilisi, Georgia), and a PhD degree from Palacky University (Olomouc, Czech Republic), in collaboration with the CRC Institute for Cancer Studies, University of Birmingham Medical School (Birmingham, United Kingdom). Her pathology training included an anatomic pathology residency at Queen’s University (Kingston, Ontario, Canada), and gynecologic and breast pathology fellowships at Memorial Sloan Kettering Cancer Center (New York, New York). Before her residency training, Turashvili completed a Canadian Institutes of Health Research Fellowship at the British Columbia Cancer Research Center (Vancouver, British Columbia, Canada), where she was involved in the landmark METABRIC (Molecular Taxonomy of Breast Cancer International Consortium) study.
Turashvili has coauthored more than 100 peer-reviewed publications and book chapters. She serves on multiple national and international committees, including the Abstract Review Committee and Membership Committee of the United States and Canadian Academy of Pathology, the CheckPath Anatomic Pathology Committee of the American Society for Clinical Pathology, the NeoSTEEP Working Group of the National Cancer Institute and the Breast Cancer Surveillance Consortium (NCI-BCSC), the Malignant Germ Cell International Consortium (MaGIC), and the Pathology Work Group of International Gynecologic Cancer Society. She is the deputy editor of gynecologic pathology at PathologyOutlines and serves on the editorial boards of peer-reviewed scientific journals. In 2022, Turashvili was inducted into the Emory University MilliPub Club, which honors current Emory faculty who have publications that have each garnered more than 1000 citations. She also received a 2022 Emory School of Medicine Researcher Appreciation Day Recognition.