Strategies for obtaining bone biopsy specimens from breast cancer patients – Past experience and future directions

Abstract

BackgroundCancer and its treatment can have multiple effects on the bone. Despite the widespread use of in vivo and in vitro models, it is still necessary to understand these effects in humans. Obtaining human bone biopsies is technically challenging and in this article we review the experiences from the Ottawa Bone Oncology Program.MethodsA series of bone biopsy studies in breast cancer patients with and without bone metastasis have been performed. We reviewed the results of these studies and present them in a descriptive manner. We discuss lessons learned from each project and how they have affected future directions for research.ResultsSince 2009, 5 studies have been performed accruing 97 breast cancer patients. Study endpoints have ranged from comparing the yield of malignant cells from CT-guided versus standard iliac crest biopsies, to studies assessing the feasibility of micro-CT analysis on Jedhadi trephines to evaluate bisphosphonate effects on bone micro-architecture. More recently, we have assessed the feasibility of performing repeat bone biopsies in the same patient as well as evaluating the practicality of obtaining bone tissue at the time of orthopaedic surgery.ConclusionHuman bone tissue is an important biological resource. Our experience suggests that obtaining bone biopsies is feasible and can yield adequate amount of tumour cells for many studies. However, these remain technically challenging specimens to obtain and given the rapid advances in cancer therapeutics and the use of potent adjuvant bone-targeted agents, more centres need to be involved in these types of studies.

Unlocking bone for proteomic analysis and FISH

“…A significant percentage of primary breast tumors and their metastases show discordance in their estrogen, progesterone and HER2 receptor status [18,[37][38][39][40][41], with previously reported discordance rates of 7-54, 20-54, and 3-33%, respectively. Routinely determining the receptor status of bone metastases could significantly change patient management, as demonstrated in a pilot study, where 20% of breast cancer patients received altered care from their primary physician after including IHC/FISH diagnosis of bone metastases [41].…”