the ball bounces back: opinion on whether metastatic spread from core biopsy changing

[Lani]

AACR 2008: ABSTRACT #LB-95: Evidence for increased metastatic dissemination after core needle biopsy of breast cancer in an in vivo model of human tumour metastasis
[American Association for Cancer Research]
The standard of care in the investigation of clinically or mammographically detected breast cancer is a core needle biopsy. Several studies have demonstrated tumor cell displacement along needle tracks and into draining lymph nodes following core needle biopsies. The clinical consequence of this observation remains the subject of ongoing debate. We hypothesized that the biological tumor response to core needle biopsies would result in increased tumor growth, vascular migration and distant spread of viable malignant cells. To test our hypothesis we used MDA-MB435 cells grown on the chorio-allantoic membrane (CAM) of 8-day-old chick embryos. Our results demonstrated that core needle biopsy significantly increased the overall metastatic burden in a number of distant organs [Fig 1]. Additionally, evidence was seen for a biopsy induced trophic shift in the pattern of metastatic dissemination observed in the biopsied chick embryos when compared to the pattern of metastases observed in non-biopsied tumors [Fig 2]. Our experimental results support clinical reports of tumor cell displacement into lymph nodes following core needle biopsies. Additionally, these findings suggest that the change in pattern of increase in metastasis observed in biopsied animals is related, at least in part, to a biological alteration (trophic change) in the breast cancer cells and or tumor microenvironment resulting from the core needle biopsy, rather than being entirely a consequence of mechanical displacement of cells into the surrounding vasculature.
http://www.docguide.com/news/content...D0060C157(less technical coverage)

[StephN]

Hi Lani -
I had missed this one. The book of abstracts for the AACR conference is at least as big as the Seattle phone directory! We tried to focus on breast cancer related sessions and posters, but there were dozens!

My question: Is the thinking turning to going from a needle to excisional biopsy and NOT taking the accepted second step of a core biopsy?

One reason I ask is that my needle biopsy missed my tumor and I was sent for a core biopsy next. The needle missed as my body was surrounding my tumor with normal fatty and fibrous tissue in which the tumor was embedded closer to my chest wall. The core biopsy was also inconclusive so I then had the excisional biopsy. This put off my deciding on an onc/treatment for about a month while waiting for the dx and pathology.

Maybe my case is a rare instance, but this is what happened to me. I had distant mets very quickly.

[Hopeful]

Lani, your link doesn't work, as I think you got part of your sentence tangled up in it. It would be great if you could repair it, as I would like to read this report.

Makes me happy I backpedaled on the core biopsy and just went for the excisional.

Hopeful

[swimangel72]

This article makes me happy that I went for a mastectomy - even though the biopsy said my tumor was Stage 1. Later, when I finally found out that I was Her2+, I was even more happy I had the masectomy. (I'm still not-so-happy that I had the Diep reconstruction, what with the staph infection and abdominal incision, but ask me again in a year.)

ANYWAY - I remember when I had my needle-biopsy (sonogram assisted, vaccuum type) - I kept thinking, "I wonder if the needle will spread the cancer cells even further?" It does seem to make sense, even to a non-scientist like me - if they can duplicate this study, treatments will have to change to be less invasive. Thanks Lani for posting this info!

[Lani]

I am lousy at "linking"

http://www.docguide.com/news/content...25742D0060C157

[KelliD.]

I had an excisional biopsy, but w/ a wire localization. Would that count, also as a needle maybe spreading the cancer?!

[Becky]

I have always felt "certain" that my micromets in my sentinel node were from my needle biopsy (which was inconclusive anyway). My breast was sore and totally black and blue (which means there was significant blood spread).

That's my thought on it. If I ever need another I will insist that they just remove the offending tissue.

[harrie]

When my oncologist advised me to have chemo because of possible microscopic cancer cells in the bloodstream, one of my first thoughts was "wow, what about the cells that might have gotten away from core biopsy???!!?" Because I remember the 2 punches as the needle was inserted and the bruising afterwards.
Maryanne

[RhondaH]

KNEW it was cancer "so, do you want me to biopsy it or just take it out" as I told him, "I'm not THAT vain OR attached to it...so take it out" and he only did the excisional biopsy and later went in to clean the margins which were fine.

Rhonda

[Paris]

Having had a core needle biopsy but being node negative by sentinel node biopsy do I have nothing to worry about?

With each bit of research and information sometimes creating more confusion for me it reminds me to live each day to the fullest.

Jamie