A case of mucinous carcinoma of the breast in which needle tract seeding was diagnosed by preoperative diagnostic imaging

Abstract

Herein we report a 62-year-old woman with an excisable breast tumor in whom needle tract seeding was suspected during preoperative ultrasound and magnetic resonance imaging (MRI). A tumor of the right breast was observed during initial examination, and she was referred to our hospital after fine-needle aspiration cytology led to diagnosis of breast cancer, even though core needle biopsy results were negative. Mammography showed a high-density mass with a portion of the margin exhibiting very fine serrations. Ultrasonography revealed a circular mass with a border that was indistinct in some regions, and a hypoechoic band that extended from the tumor toward the skin. A mass was observed on MRI, with a linear enhancement extending on the skin side, and needle tract seeding was suspected. Fine-needle aspiration cytology revealed malignancy, and the histological appearance was consistent with mucinous carcinoma. T1cN0M0 stage I breast cancer was diagnosed, and wide excision and sentinel lymph node biopsy were performed. The skin directly above the tumor was concurrently excised to remove the biopsy puncture site. Histopathological diagnosis confirmed mucinous carcinoma, with the tumor observed to extend linearly into the subcutaneous adipose tissue in a pattern corresponding to the biopsy puncture site. The stump of the excised breast was negative for cancer cells. The possibility of tumor seeding must be considered during fine-needle aspiration cytology and biopsy. As demonstrated in this case, diagnosis of such seeding through preoperative imaging may enable extraction of the entire lesion, including the needle tract.

Malignant Seeding Following Percutaneous Breast Biopsy: Documentation With Comprehensive Imaging and Clinical Implications

“…On the other hand, Brown confirmed work done decades ago that circulating tumor cells following surgical preparation of an operative breast site can be found, with no direct clinical implications (9). Ishizuna et al described observing at ultrasound a hypoechoic band extending from the targeted tumor toward the skin following a negative core biopsy and subsequent positive fine-needle aspiration biopsy (5), which they reported as more likely with mucinous lesions. However, no other report has validated this observation.…”

“…Ishizuna et al. described observing at ultrasound a hypoechoic band extending from the targeted tumor toward the skin following a negative core biopsy and subsequent positive fine‐needle aspiration biopsy (5), which they reported as more likely with mucinous lesions. However, no other report has validated this observation.…”

“…In addition, outcomes have not supported malignant seeding. Chen et al., reported a recurrence‐free rate at a mean follow‐up of 4.9 years (range 2.0–8.9) to be less for patients undergoing percutaneous CNB than non‐image guided biopsy (5). This conclusion was supported by a retrospective review of 719 patients where 189 had and 530 did not have percutaneous biopsy procedure.…”

A technical note: pre-operative ultrasound-guided wire localization in head and neck surgery

“…Needle tract seeding is a recognized complication-related lesion puncture at biopsy. With respect to the breast, stereotactic biopsy needle tract seeding has been documented in cases of mucinous adenocarcinoma [10], and similar cases are reported in tumors of the chest [11] and abdomen [12]. In a review of over 16,000 abdominal biopsy procedures, the authors calculated the risk of needle tract seeding as between 0.0003 and 0.0009% [13].…”

Carcinoma mucinoso invasor da mama e seus diagnósticos diferenciais em biópsia por agulha grossa: revisão da literatura

“…Esse tipo de ocorrência é dado de acordo com o calibre da agulha utilizada, além do tipo histológico do tumor, chamando a atenção para alto risco entre carcinomas mucinosos e tumor phyllodes (10) .…”