Can the core biopsy spread cancer?

iwannabefree50

Does anyone know this? Have they done a study? I am worried. It seems like stirring up trouble to be poking around in cancerous cells and might possibly be setting them loose to be spread. I know I am worrying. I had cancer once. Had a mastectomy. Now I just had a couple biopsies in the other breast and It is so bloody and painful. I am so tired. I know I am imagining cancer being spread into my bloodstream and lymph vessels. Can that happen?

It's ok. Tell me I am crazy!

MelissaDallas

That has pretty much been discounted.

SelenaWolf

To my knowledge, biopsy-related spread - while theoretically possible - has never had a documented case.

iwannabefree50

Thank you, ladies!

leaf

https://community.breastcancer.org/blog/what-my-pa...

If a breast biopsy shows breast cancer, then in some cases, cells are moved. http://www.ncbi.nlm.nih.gov/pubmed/19167175 However, if they are going to pose a problem, they need to not only move, but also grow at their new site. This study concluded that Although data are limited, no increased morbidity has been associated with iatrogenic seeding after CNB.

There are some theories that some breast cancers may self-seed or cross-seed on their own (without any biopsy or surgical manipulation). http://www.discoverymedicine.com/Elizabeth-A-Comen/2012/08/22/tracking-the-seed-and-tending-the-soil-evolving-concepts-in-metastatic-breast-cancer/

Anonymous

remotely possible, but highly unlikely

Anne

obsolete

It's sooooo very sad that patients are not informed by their doctors. I must support the OP's concern, in that mechanical detachment can and did occur resulting from core needle biopsies. Seeing is believing.....evidence of mechanical detachment:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC176977...

Some BC subtypes are more prone to mechanical detachment and seeding (of cancerous cells) during core needle biopsies, and there is suspicion in my case with invasive papillary carcinoma. Thus, some frank invasions (into stroma or LVI - lymphatic-vascular system) may not necessarily be "biological" in root cause, but "mechanically" caused by the core needle biopsy procedure itself. Biopsies performed on papillary carcinoma, for example, are best done via FNA (fine needle aspiration) or by full excision biopsy only. There are several medical studies on this topic. ***links follow

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*** Mechanical detachment: "Clinically, it is possible that local invasion may be related to tumor displacement." Grabowski J, Salzstein SL, Sadler GR, Blair S. Intracystic papillary carcinoma: A review of 917 cases. Cancer 2008;113:916-20. Image(s) of pseudo-invasion due to displacement: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769773/figure/f1/ ;

"... that the epithelium of papillary lesions can be dislodged and displaced into the surrounding stroma, often in the needle tract, and even into adjacent lymphatic channels, more frequently than other breast lesions (due to inherent friability of papillary lesions) ...... in this study, 3 patients showed associated events;" http://slap-patologia.org/wp-content/uploads/2014/04/encapsulated-papillary-ca.pdf

1. Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast. "It is likely that intracystic papillary carcinomas are particularly prone to this artefact because friable tumour fragments escape, accompanied by cyst fluid, when the capsule is punctured by a 14G core biopsy needle." http://www.ncbi.nlm.nih.gov/pubmed/12354808;
2. Pseudo-invasion may be due to prior core biopsy causing epithelial displacement (J Clin Pathol 2002;55:780) http://www.pathologyoutlines.com/topic/breastmalignantintracysticpapillary.html; …............ .Douglas-Jones, et al;
3. "Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast"; "It is possible that intracystic papillary lesions are particularly prone to the problem of epithelial displacement because of the delicate friable nature of the tumour. The lesions presented here had a cystic component and a papillary architecture. They were also sampled using 14G core biopsy needles. Once the capsule of such a lesion is punctured, cystic fluid under pressure carrying exfoliated epithelial cells may escape into the surrounding tissues and cells become incorporated into the subsequently forming granulation tissue.... Douglas-Jones, et al; "Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast"; "Displacement of tumour fragments has been shown to be a particular problem associated with assessment of stromal invasion in intracystic papillary carcinomas of the breast. This may be the result of the friable nature of the tumour and intracystic pressure, which is released when the tumour is biopsied using 14G core biopsy needle.""in one case this gave rise to pseudovascular invasion." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769773/

SelenaWolf

Papillary carcinomas are a rare type of breast cancer. About 0.5% of newly diagnosed cases of breast cancer are this type (see: link below). In the study of 302 patients that you quoted above, only 3 showed possible evidence of "seeding" from biopsy. That's about 1% of the patients studied that may have been affected. The phrase "clinically possible" above is key. The study did, indeed, posit the theory that it is clinically possible for "seeding" to occur when doing a biopsy of papillary carcinoma with a 14G core biopsy needle. "It is possible that intracystic papillary lesions are particularly prone to the problem of epithelial displacement because of the delicate friable nature of the tumour..." Again the word "possible" and the phrase "may be" are used.

None of us are disputing the possibility that this can happen. It's just not likely that it will. Correlation does not mean causation. Certainly, it's important to keep studying the effects of biopsy on all types of tumors because everything is possible, but - statistically and scientifically - the risk of "seeding" remains very, very small, even with papillary carcinoma.

However, like you stated on another thread, those women who have this type of tumor may wish to closely question their doctors about this to ensure that they are completely informed before they consent to biopsy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3244819/

obsolete

Good points, Ms Selenawolf, although the presence of epithelial cells in examined sentinel lymph nodes can actually sometimes be reasonably explained by mechanical transport. Although historical statistical data is lacking, this potential phenomenon could possibly affect more patients than what Ms. Selenawolf postulates here as 0.5% (eg BC patients with a specific papillary carcinoma DX). Please read the last link below about 53 cases, then add into the equation my strange suspect case (dx of invasive mucinous carcinoma associated with papillary carcinoma and DCIS). Yeah OK, my case is weird We all need to further advocate and help one another research the risks of every needle/surgical related procedure, rather than debating trivial statistical data because we're all sisters. There's evidently not been enough public research on this phenomenon for all of us to be aware of such risks, no matter how small. The scarey aspect is that the biological significance is unknown at this point. If you have other data links to share, please do.

It's interesting the common denominator appears to be NOT limited exclusively to "papillary carcinoma", but the little research thus far leans toward "papilloma" formations being at higher frequency risk for this phenomena, which can also present as DCIS with papillary patterns, IDC with micropapillary pattern or other ductal invasive carcinoma (colloid/mucinous) with or without DCIS and/or papillary carcinoma being necessarily present. For one example, conventional IDC can sometimes present in a non-conventional papillary background. For 7 other different presentations (IDC & DCIS) of partial mechanical disruptions of tumors, see link below:

"The use of needle core biopsy (NCB) as part of triple assessment for non-operative evaluation and diagnosis of breast lesions is now routine practice. Trauma to breast tissue during NCB may result in displacement of breast epithelium and may lead to diagnostic difficulty in subsequent excision specimens..... epithelial displacement is more likely to occur when the interval between NCB and surgical excision is short ….In particular, the time interval between NCB and surgical excision appears to be relevant." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC200110...

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"The sentinel lymph nodes of the patients we describe herein were found to contain epithelial cells with benign cytologic features and morphologic and immunophenotypic characteristics different from the cells of the patients' respective underlying tumors. It is likely that these sentinel lymph nodes became falsely positive secondary to the combination of needle-induced iatrogenic epithelial cell displacement and benign transport of epithelial cells, both recently described phenomena. The vast majority of such cases occur in the context of carcinoma involving an intraductal papilloma." Axillary Sentinel Lymph Nodes Can Be Falsely Positive Due to Iatrogenic Displacement and Transport of Benign Epithelial Cells in Patients With Breast Carcinoma http://jco.ascopubs.org/content/24/13/2013.full

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Epithelial Displacement in Breast Lesions

Chandandeep Nagi, MD; Ira Bleiweiss, MD; Shabnam Jaffer, MD .

"Displacement of epithelial cells (DE) in the breast is a recognized phenomenon that may occur after needling procedures such as fine-needle aspiration biopsy,core needle biopsy, needle localization, suture placement,and infiltration with local anesthetic. Both benign and malignant epithelial cells can be displaced into the biopsy site, needle tract, lymphatic channels, and axillary lymph nodes. Despite the fact that the biologic significance of these findings is currently unknown, it is important to recognize this iatrogenic artifact, so that these findings are not misinterpreted as stromal or lymphatic invasion, especially in cases of benign breast lesions and pure ductal carcinoma in situ (DCIS)."

—Displacement of epithelial cells (DE) in the breast may occur after various types of needling procedures.

—A review of our computer files from January 1994 to June 2004 yielded 53 cases with DE. …..

Results: —Needling procedures included 1 or more of the following: ultrasound-guided core biopsy (24 cases), mammotome core biopsies (16), fine-needle aspiration (8), anesthetic injection (3), suture placement (5), and wire localization (1). Procedures were performed in order to investigate a mass (34 cases), calcifications (15), both (3), or nipple discharge (1). The time from needling to surgical procedure yielding a specimen with DE ranged from minutes to 47 days. Displacement of epithelial cells occurred in the following sites: biopsy tract (42 cases), lymphatic channels (5), both biopsy tract and lymphatic channels (4), and breast stroma (2). The diagnoses included intraductal papilloma (6 cases) and intraductal carcinoma (DCIS) (45; 15 with invasive carcinoma). The remaining 2 cases were invasive carcinoma (colloid and papillary types) devoid of DCIS. Of the DCIS cases, either pure or with invasive carcinoma, the pattern was micropapillary in 23, intraductal papilloma involved by DCIS in 32, and both features in 12. The remaining 2 cases of DCIS included comedo DCIS and cribriform DCIS involving a cyst. Conclusions: —With the exception of 3 cases, DE was associated with 1 or more underlying papillary lesions, including pure intraductal papilloma, DCIS involving intraductal papilloma, micropapillary DCIS, and invasive carcinoma. Other etiologies included mucinous carcinoma and cystic lesions, with only 1 case in which a mechanism for DE could not be postulated."

http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282005%29129%5B1465%3AEDIBLA%5D2.0.CO%3B2

Hopeful82014

Kay, I was unaware of that info on removal of the needle track during lx. Do you have any links to more info on that?

I've had 2 biopsies and it's been several months since the last one so I'm curious as to how the track would be determined. Not that it's important - I'm just curious. . Thanks for your always valuable input.

Hopeful82014

Many, many thanks, Kay!

Hopeful82014

I totally agree, Kay. Thank you for elucidating it so clearly.