Local Recurrence of Breast Cancer after Skin-Sparing Mastectomy Following Core Needle Biopsy: Case Reports and Review of the Literature

Abstract

The latest advances in diagnostic and therapeutic procedures for breast cancer have provided valuable technological breakthroughs. Yet the long-term consequences of these modern methods are still quite unclear. Such is the case for stereotactic or ultrasound-guided histologic needle biopsy and skin-sparing mastectomy. We report on three patients who presented with multicentric breast cancer diagnosed by stereotactic needle biopsy and treated by skin-sparing mastectomy. All three patients developed recurrence at the core needle entry site. Records of 58 patients with breast cancer who were treated by skin-sparing mastectomy followed by immediate reconstruction (with transverse rectus abdominis muscle [TRAM] flap or tissue expander) at the Breast Diseases Division of Buenos Aires British Hospital between December 1999 and December 2003 were reviewed retrospectively. Eleven of these patients were diagnosed by histologic needle biopsy. The mean follow-up was 28 months (range 5-60 months). Three (skin or subcutaneous) local recurrences at the needle entry site, diagnosed in a mean time of 23.6 months (16, 22, and 23 months), were reported. The three patients underwent complete resection with clear margins, radiation therapy to the "neobreast," and tamoxifen. All three patients are disease free with a mean postrecurrence follow-up of 24.3 months (30, 23, and 22 months). Based on the evidence of displacement of tumor cells and the potential nonresection of such tumor seeding at the time of skin-sparing mastectomy, as well as the poor probability of postoperative radiation therapy, we recommend surgical resection of the needle biopsy tract, including the dermal entry site, at the time of mastectomy.

Photodynamic therapy with intratumoral administration of Lipid‐Based mTHPC in a model of breast cancer recurrence

“…This seeding is not clinically relevant since the host immune system will eliminate most surviving tumor cells, as will subsequent surgery, radio or chemotherapy [2]. Skin sparing mastectomy however offers a different scenario with AE 5% observed local recurrences within the biopsy tract [3]. Treatment options are frequently limited with regard to previous surgery and adjuvant therapies.…”

Oncological and aesthetic considerations of skin-sparing mastectomy

“…The importance of excising previous percutaneous biopsy sites is highlighted by evidence of LR at the needle entry site. However, this is not routinely undertaken by all surgeons [4]. SSM can facilitate IBR, utilising the native skin envelope optimises the final contour of the reconstructed breast, resulting in excellent cosmesis, minimising scarring and post-mastectomy deformity, decreasing the skin donor area and reducing the need for contralateral breast adjustment in order to achieve symmetry [5].…”

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].…”

“…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.…”