Neoadjuvant chemotherapy provides today a valid option for many patients with primary breast cancer. For evaluation of treatment response as well as for biomarker studies for prediction of response, an efficient collaboration between pathologists and gynaecological oncologists is essential. This report reflects aims and indication according to the current opinion, describes advantages and disadvantages in comparison to the conventional adjuvant approach and provides guidelines on how to conduct the whole treatment concept of neoadjuvant therapy. Current and projected study concepts of preoperative and following postsurgical treatments in Germany are introduced. While the basic principles of histopathological evaluation of tumour specimens from neo-adjuvant breast cancer studies are similar to conventional surgical therapy, some aspects of histopathological management are of special importance in these studies.