The impact of preoperative breast biopsy on the risk of sentinel lymph node metastases: analysis of 2502 cases from the Austrian sentinel node biopsy study group

Abstract

Preoperative breast biopsy might cause disaggregation of tumour cells and tumour cell spread. The purpose of this study was to investigate the impact of preoperative biopsy on the rate of metastases to the sentinel lymph node (SLN) of patients with primary breast cancer. We report the results of 2502 patients with primary breast cancer, who were operated, and a sentinel node biopsy was performed. The association of preoperative biopsy with the risk of SLN metastases was examined by regression analyses and tested for possible confounding well-known factors for axillary node metastases. In all, 1890 patients were available for final analyses; 1048 (55.4%) patients had a preoperative diagnosis performed by fine-needle aspiration or core biopsy; 641 (33.9%) patients had a positive SLN when conventional H&E and IHC staining was performed. Patients with preoperative breast biopsy showed a 1.37 times (95% CI, 1.13 -1.66) increased risk of SLN metastases on univariate analysis, but this result was not persistent when analysis was adjusted for other relevant factors for axillary node metastases, OR 1.09 (95% CI, 0.85 -1.40). In addition, subgroup analyses of the risk for occult micro metastases to the SLN (detected by IHC only) on H&E-negative cases also showed no increased risk associated with preoperative biopsy, OR 1.07 (95% CI, 0.69 -1.65). The conclusion, based on the present data, is that preoperative breast biopsy does not cause artificial tumour cell spread to the SLN, with possible negative impact on the prognosis of breast cancer.

The clinical significance of sentinel lymph node micrometastasis in breast cancer

“…It is also noteworthy that several reports have identified associations between percutaneous biopsy of the primary tumour and SLN involvement with tumour, including MM [76,77]. Moore et al [78] found that the presence of MM was significantly related to the method of breast biopsy, however this relationship was only observed for IHC detected MM rather than those identified by HE staining.…”

Office management of a palpable breast lump with aspiration

“…15 If the lump proves to be cancerous, there is no evidence that a needle biopsy will cause the tumour to spread. 16 In fact, most cancers are diagnosed by a needle or core biopsy before surgery.…”

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

“…Moreover, our data provide evidence that the induction of cancer cell spreading over lymphatics by fine needle biopsy may be limited to non-clinical significance as the number of lymph node involvement did not differ significantly between the two patient groups. This has been supported by the study of Peters-Engl et al, who showed that preoperative core nedle biopsy did not lead to artificial tumor cell spread into the sentinel lymph nodes [28]. The increased survival in patients with preoperative core needle biopsy has to be interpreted with caution due to the low number of events, this is almost certainly an irrelevant observation.…”