Abstract: Neoadjuvant therapy (NAT) plays a critical role in the comprehensive treatment of breast cancer, with tumor size changes serving as a primary indicator for evaluating response to treatments. Tumor shrinkage pattern (TSP) following neoadjuvant chemotherapy is a valuable supplement to traditional response assessment, providing insights into the morphology, distribution, and degree of enhancement of breast tumors after NAT. Recently, TSP has gained significant attention for its potential in guiding breast-conserving surgery decision, evaluating prognosis, and predicting complete pathological response. However, TSP evaluation typically relies on clinicians’ experience, and no standardized criteria currently exist. Emerging imaging technologies are being applied to improve TSP prediction and comparison. This review summarizes recent advancements in NAT pathology, TSP classification methods, evaluation technologies and their clinical applications.