Breast cancer neoadjuvant treatment response gives a unique opportunity to assess the therapy effectiveness only a few months after the therapy was initiated. In many neoadjuvant trials, patients achieving a pathologic complete response, showed a better long-term outcome, indicating pathologic complete response as a strong prognostic marker. However, there are some discrepancies in pathologic complete response assessment, thus standardization is needed. The review addresses the important issues regarding pathologic complete response assessment.