Do FNA and Stereotactic Core Needle Biopsy cause "seeding"of BC?

Hi,

As someone in her early 50's who had her first lump surgically removed at the age of 17, I can tell you that back then it was normal to have surgery with anesthesia to have a lump removed and checked to see if it was cancer. I had another one at 19, surgery with anesthesia, to find again it was benign. By the time I had my third surgery in my 20's, the normal procedure was to have it removed with a "local" in the hospital instead of having anesthesia. As time progressed, the final biopsy at age 49, which showed IDC was a stereotactic. I took it as the progression of medicine, learning newer and less invasive methods to achieve the same results. But I do understand your concern. I too was worried that the last biopsy had spread the cancer, but I would have had the same worry about spreading the cancer if it had been diagnosed in 1977 with the first surgical biopsy where the lump was removed "in tact" as well. I think that comes from having heard so many times through my life others comments about cancer patients, " you know they were doing so well until that Dr did _ _ and the it just spread all over. I think the truth is, we never really know how we got it, just as we never know how or if it will spread. I do think the stereotactic biopsy is the best available now. Even with my fear, I don't regret having it. I hope you will find peace with it too.

I don't know where you got your information on testicular biopsy, but it is absolutely incorrect, as here described by the NIH.



http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004357/



There are also far more reliable sources than the website you are referencing. I would suggest, National Cancer Institute, Pubmed or Johns Hopkins Sites for accurate information.

smillsbc,

What it comes down to is that seeding is a possibility with any surgical instrument, whether it's a needle or a scalpel. Fortunately seeding appears to be very rare and it appears that seeded cancer cells may not have the ability to survive. Additionally, any seeding that occurs is likely to be will be addressed by post-surgical treatments such as radiation or hormone therapy.  Moving to a surgical biopsy instead of a needle biopsy doesn't eliminate the small risk of seeding and instead opens the patient up to significantly greater risk from the surgery itself, from post-surgery complications, and from the long term effects of surgery, such as internal scarring.

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Here is the full Hansen study.  The conclusions are somewhat different that what was presented on the website that you linked: 

Manipulation of the Primary Breast Tumor and the Incidence of Sentinel Node Metastases From Invasive Breast Cancer

I'd suggest that you read the comments in the discussion tab of the article.  Dr. Hansen has some interesting things to say:

"I think the findings of this study are interesting, but currently have not changed our management. We still perform fine-needle aspirations and core biopsies to diagnose cancer. Until I have a good explanation as to why this is happening, we will continue our current practice because it does afford the patient the opportunity to make treatment decisions prior to surgical therapy."  In other words, Dr. Hansen is still doing needle biopsies even after this study. 

"I want to emphasize that what we are reporting is an association between the type of biopsy and the incidence of sentinel node metastasis. We have no definitive proof that the type of biopsy actually leads to the metastasis."

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Here is another study that was similar to the Hansen study but had different results: 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

"This study examined the risk of SLN metastases in patients who underwent prior FNA or large-gauge needle core biopsy. Our results do not confirm the findings of a recently published study, performed on a much smaller number of patients (Hansen et al, 2004), suggesting a positive association between needle biopsy and SLN metastases. Studies of SLN metastases must take into account all well-known predictive factors for axillary node metastases such as tumour size, clinical and histo-pathological criteria. The significant result of an increased risk for SLN metastases after preoperative biopsy obtained on univariate calculation was no longer present when adjustment for relevant predictors for axillary node metastases was done by means of multivariate analysis....

...The present data clearly indicate that preoperative biopsy does not increase the risk of metastases to the SLN in patients suffering from breast cancer. There is no evidence for any tumour cell spread to the sentinel node with possible negative impact on the prognosis of breast cancer. In conclusion, preoperative breast biopsy is a safe method and should be used to achieve definitive diagnosis of malignant breast lesions."

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Here is a more complete review, from 2011, of many of the studies done on breast cancer needle biopsy seeding:  Seeding of tumour cells following breast biopsy: a literature review  Some interesting excerpts from this article:

"Tumour displacement was seen less frequently as the interval between biopsy and surgical excision lengthened. For example, tumour cell seeding was seen in 42% of patients when the interval between biopsy and excision was less than 15 days, but this was only seen in 15% of tumours excised more than 28 days after biopsy. This reduced the incidence of seeding down the needle track with time and was significant (p<0.005). This suggests that seeded cells do not survive displacement."

"Overall, based on the findings of this review, the likelihood of tumour recurrence as a consequence of a biopsy procedure appears very low. Nevertheless, vigilance from both surgeons and radiologists for this potential complication is still advised. However, this knowledge should not interfere with surgical techniques that may benefit the patient by limiting procedural morbidity and improved cosmesis. Anxious patients, who may inquire about this potential complication, can be reassured that, although it does occur at a microscopic level, the clinical effect appears negligible and biopsy as a cause of disease recurrence appears very rare."

smillsbc, 

I'm in Canada and here the referring Radiologist most definitely does not profit directly from any needle biopsies they do.  I don't think the biopsy rates here are any different than they are in the U.S. and I don't think that the 80% benign rate is any different either. 

It also seems to me that much of the time when a Radiologist gives an image a BIRADs3 rating and recommends a 6 month follow-up rather than a needle biopsy, it's the patient who balks at that and wants to have the biopsy right away.  We see that on this board pretty much every day. 

roche, your scenario is concerning indeed. This thread, unfortunately, hasn't been active in over 4 years. I am worried that you won't get much response, and that is what you're looking for right now. What would you think about posting your info/question in the IDC forum (instead of here in the not diagnosed but concerned/waiting for test results forum)? I think you might get more knowledgeable responses there.

roche...Best wishes to you. You definitely have great stats with a grade 1, stage 1 (less than 1 cm) and negative nodes. ER+, PR+ and Her2- as well. Good for you!