The association between methods of biopsy and survival following breast cancer

Abstract

Percutaneous biopsy in breast cancer has been associated with an increased risk of malignant cell seeding. However, the importance of these observations remains obscure due to lack of corroborating evidence from clinical studies. We determined whether method of biopsy is associated with breast cancer survival. This hospital registry-based cohort study included 3416 non-metastatic breast cancer patients diagnosed from 1993 to 2011 in a tertiary setting. Factors associated with biopsy methods were assessed. Multivariable Cox regression analysis was used to determine the independent prognostic impact of method of biopsy. Overall, 990 patients were diagnosed by core needle biopsy (CNB), 1364 by fine needle aspiration cytology (FNAC), and 1062 by excision biopsy. Excision biopsy was significantly associated with more favorable tumor characteristics. Radiotherapy modified the prognostic impact of biopsy method (P interaction < .001). Following multivariable analysis, excision biopsy was consistently associated with lower risk of mortality compared to FNAC in women receiving adjuvant radiotherapy (adjusted hazard ratio: 0.81, 95%CI: 0.66–0.99), but not in those who did not receive adjuvant radiotherapy (adjusted hazard ratio: 0.87, 95%CI: 0.65–1.17). While the risk of mortality was not different between patients undergoing FNAC and CNB when radiotherapy is administered, in the absence of radiotherapy, CNB was associated with higher risk of mortality than FNAC (adjusted hazard ratio: 1.57, 95%CI: 1.16–2.12). Given that our results contradict with findings of previous clinical studies assessing the prognostic impact of method of biopsy in women with breast cancer, further studies are warranted.

Local progression of needle tract metastases during neo-adjuvant chemotherapy after core biopsy in breast carcinoma: A case report

“…They advise to avoid multiple punctures and recommend the use of 14-gauge needles or smaller. Kong et al [25] found in their observational study with 3416 patients a worse survival in patients diagnosed by biopsy than in those diagnosed by local excision. They suggest a role for hematogenic spreading after biopsy.…”

The influence of preoperative biopsy on the surgical method in breast cancer patients: a single-center experience of 3,966 cases in China

“…Previous studies have reported that the positive rate of cytological examination of CNB syringe lavage fluid can reach 65% (25), and pathological examination shows that the tumor implantation rate in the syringe can reach 50% (26). Other studies have reported that the prognosis of patients that undergo biopsy is significantly lower than that of patients with tumor resection (27). Diaz et al reported that 32% of resected specimens were implanted in the needle channel, with 21.6% in 1-2 nests and 10.8% in multiple nests, while the tumor implantation rate in the CNB group was significantly higher than that of the VABB group (37% vs. 23%, P<0.05) (28).…”

“…At present, whether percutaneous tumor biopsy will cause tumor cells to be implanted in soft tissue or skin around the tumor remains debatable (1)(2)(3)(25)(26)(27)(28)(29). Previous studies have reported that the positive rate of cytological examination of CNB syringe lavage fluid can reach 65% (25), and pathological examination shows that the tumor implantation rate in the syringe can reach 50% (26).…”

Survival Outcomes of Patients With Breast Cancer Diagnosed Using Vacuum-Assisted Biopsy: A Nationwide Study From the Korean Breast Cancer Society

“…In terms of prognosis, however, besides FNA, there was no difference among the various biopsy methods. One of the factors affecting the association between biopsy methods and prognosis is the displacement of tumor cells into the biopsy tract [ 16 17 ]. Kong et al [ 17 ] demonstrated poor prognosis in patients with breast cancer who were diagnosed using CNB rather than using FNA if they did not undergo postoperative adjuvant radiotherapy, which could be associated with an increased risk of tumor cell displacement caused by using larger needles.…”

“…One of the factors affecting the association between biopsy methods and prognosis is the displacement of tumor cells into the biopsy tract [ 16 17 ]. Kong et al [ 17 ] demonstrated poor prognosis in patients with breast cancer who were diagnosed using CNB rather than using FNA if they did not undergo postoperative adjuvant radiotherapy, which could be associated with an increased risk of tumor cell displacement caused by using larger needles. However, Liebens et al [ 18 ] performed a systematic review and showed that risk factors such as the interval period between biopsy and surgery [ 19 ] and histologic type [ 20 ], rather than the size of the biopsy needle, may have affected the tumor cell displacement.…”