Local breast cancer recurrence caused by mammographically guided punctures

Abstract

Purpose: To evaluate the risk of needle track seeding or tumor cell implan-Key words: Breast neoplasms, tation as the cause of locally recurrent breast cancer after breast conserving recurrence; mammography, presurgery. operative localization; fine-needle Material and Methods: We reviewed recurrences from a consecutive series of aspiration biopsy. 303 clinically nonpalpable breast cancers treated with breast conserving surgery after pre-operative localization. The median mammographic follow-up was 5.4Correspondence: Erik Thurfjell, years. The suspicion of seeding or implantation was based on the location of Section of Radiology, University the recurrent lesion in comparison with the needle path in two orthogonal mam-Hospital, SE-751 85 Uppsala, mographic projections. Pre-operative percutaneous biopsies had been done in Sweden. FAX π46 18 12 21 88. 71% (214/303) of the cases. Postoperative radiotherapy was administered to 82% (194/238) of the invasive cancers and to 28% (18/65) of the ductal cancers in Accepted for publication 23 March situ (DCIS).2000. Results: Locally recurrent cancer occurred in 11% (33/303) of the cases. Radiotherapy demonstrated a protective effect from relapse among invasive cancers but not for DCIS. Seeding or implantation was suspected in 3 recurrent invasive cancers which had not been subject to radiotherapy. The histopathological diagnosis of the primary cancer and the recurrent cancer were the same in these cases: adenoid cystic, mucinous and tubuloductal cancer.Conclusion: Seeding or implantation was suspected as the cause of local recurrence in 7% (3/44) of the invasive cancers which did not receive radiotherapy.

Preoperative Core Needle Biopsy does not Increase Local Recurrence Rate in Breast Cancer Patients

“…The median recurrence time was 2.3 years. [11][12][13][14]. Some authors report about a 50% seeding rate [10].…”

“…In the literature, several case reports demonstrated needle track seeding after core biopsy [10][11][12][13][14]. Recently, a prospective study with 35 patients demonstrate histological proof of tumour cell displacement in 6 patients outside the tumor within the needle track after fine needle biopsy [10].…”

Risk of needle tract seeding of breast cancer: cytological results derived from core wash material

“…However, although the chance is small, this procedure may be followed by implantation of a malignant neoplasm along the biopsy needle tract [1,[6][7][8][9][13][14][15][16]. Some investigators have reported the frequency to be 2% to 38% (Table 2) [6][7][8][9].…”

“…Two cases of needle tract seeding of mucinous carcinoma after CNB of the breast have been reported [13,15]. This study included two cases of mucinous carcinoma, and one had malignant core wash cytology, while the other had unsatisfactory core wash cytology.…”

“…Several cases of local recurrence caused by CNB have been reported [13,14,16], but some investigators have reported that the CNB technique had no impact on local recurrence after breastconserving surgery with postoperative radiotherapy, and that postoperative radiation therapy may control microscopic seeding in the needle tact [2][3][4][5]. Although Diaz et al reported that the inverse relationship between the amount of displacement observed and time to excision suggested that tumor cells do not survive displacement [6], the impact of needle tract seeding on the local recurrence and overall survival rates of patients after breast-conserving surgery without radiation has not been fully investigated.…”