Recurrence at core needle biopsy site

I had skin mets develop shortly after a biopsy as well. Staging is a weird with skin mets. For me it didn’t matter being stage 4 already (even though I had just one tumor outside of the breast at the time). I can’t say it was seeding that caused it but the timing is spot on.As for treatment they can remove the tumor and do a skin graft if necessary, they can do radiation (if the area hasn’t been heavily radiated already), or what’s called electrochemotherapy. I think there may also be a topical chemo lotion like thing, but I’m checking with my MO on this. Plus there is also regular ole systemic treatments. Mine is very aggressive and has spread over my entire right breast. It’s miserable. If I was in your shoes I would get the one tumor removed before it has a chance to do anything else.

What I worry about is having my chest port. If it’s accessed and their is skin cancer in my chest...could cancer cells be transferred to my heart via the port? Million dollar question...

I read about it while search for info about skin mets so I’m not sure if it applies to BC. If you find anything else out please share it seems like the skin mets world is small making it hard to find information.

Good luck!

I think any seasoned and knowledgeable MO would want to retest across the board with a recurrence no matter the location. BC can change and go from ER+ to ER & PR + or be negative across the board on top of the oncotype. I don’t think this happens often, but it does happen and you don’t want to fall through the cracks of assumption.

Mine went from PR+ to PR-. Testing that was no issue. The doc at the well known medical center was sure that my local docs must have just missed some of the cancer. He would not even order the oncotype if I offered to pay (my insurance did cover it). He was "certain" that radiation and then an AI would be good enough. It is frustrating to have to advocate for yourself, and hopefully your docs will order the test without you having to fight for it, and not give you the "but it is just a small recurrence" garbage. Sorry you are facing this again, but glad that you caught it. Hoping you have a plan in place soon. If my oncotype was low, the plan would have been radiation, then oophorectomy (or ovarian supression) plus an AI. Since it was high, it was chemo then radiation then AI. I did have my ovaries removed in there too.

Hoping you meet with the surgeon and MO soon to get a plan of action. Once my plan was in place, it was easier that being in limbo land.

Yes; I needed either ovarian suppression for 10 years or oophorectomy, so I chose to have my ovaries and tubes out. This way I do not need to worry about ovarian cancer. I am not BRCA postive, but do have VUS in CHEK2 and a horrible family history.

I too had a recurrence at the biopsy site. I had my DMX in March 2018. August of 2018 I went in for exchange surgery and mentioned to the surgeon a worm like growth from the biopsy scar. It was cancer which had also spread to the chest muscle. Surgeon was not able to get clear margins. In October 2018 I went in for an additional surgery with my breast surgeon and plastic surgeon to get clear margins. Additional skin and slices of my muscle were taken. I was told it looked like normal tissue. Pathologist comes back with margins not clear cancer is everywhere microscopically and is now in the lympho vascular system. Originaly my onco score was 15 so no chemo and no radiation with negative lymph nodes. But now with recurrence and lympho vascular invasion I am doing chemo then another surgery and then 33 rounds of radiation. I have gotten a second and third opinion from completely different hospitals and was told recurrence from biopsy or at biopsy site is rare less than 1%. One surgeon told me that a breast surgeon will only see one case in their entire career. Other opinions agreed with treatment I am receiving.

No lymph node involvement and I received a double mastectomy so I did not need radiation.

mellee, I just saw this thread. Any updates on your treatment plan?

I had my BC spread into the skin at the needle biopsy site too. I had a chest wall resection with a skin graft this year, and had to have a second course of radiation and more chemo. I also started ovarian suppression and will start an AI because I recurred while on tamoxifen. My cancer was high grade and high oncotype though - so they really had to hit it hard. At this point I'm only locally/regionally recurrent (PET scans are clear), so they also hit it hard in hopes of still "curing" me.

Anyway, I just wanted to offer some support and encouragement to you. It seems that although it's rare, this unfortunately DOES happen too often! Please let us know how things are going.

I've posted this elsewhere, but MD Anderson did a small study on this recently. Here is the abstract and link:

https://link.springer.com/article/10.1007%2Fs10549-017-4401-7

Abstract:

Purpose

To identify clinicopathologic, technical, and imaging features associated with neoplastic seeding (NS) following image-guided needle breast biopsy.

Methods

We performed an institutional review board-approved retrospective review of patients presenting with a new diagnosis of breast cancer or suspicious breast findings requiring biopsy with subsequent diagnosis of NS. The time from biopsy to NS diagnosis was calculated. Histology, grade, estrogen receptor (ER) status, progesterone receptor (PR) status, HER2 status, T category, and N category were recorded. Biopsy guidance method, needle gauge, and number of passes were reviewed in addition to the mammographic and sonographic features of the primary tumors and the NS.

Results

Eight cases of NS were identified in 4010 patients. The mean time from biopsy to NS diagnosis was 60.8 days. The most frequent histology was invasive ductal carcinoma (7/8). Six cases were grade 3 (75.0%). Five primary breast cancers were ER, PR, and HER2 negative (62.5%). Seven patients underwent biopsy with ultrasound guidance. Multiple-insertion, non-coaxial ultrasound-guided core-needle biopsy was done in 6 cases. Mammographic presentation of NS was focal asymmetry (3/7 cases), mass (1/7), calcifications only (1/7), or occult (2/7). Sonographic presentation of NS was most often a mass (7/8) with irregular shape (5/7) and without circumscribed margins (6/7) and was occult in 1 case (1/8). NS distribution was subdermal and intradermal.

Conclusion

High-grade, triple-negative breast cancers and multiple-insertion, non-coaxial biopsies may be risk factors for NS. NS should be suspected on the basis of the superficial and linear pattern of disease progression in these patients.

Agreed that this makes me wonder how much of the benefit of radiation is cleaning up after their own mess. Not that I'm not grateful for it. I'm glad I was able to have BCS. But I'm glad they're doing more research into it and hopefully can figure out ways to make biopsies even safer.

Mellee, I'm glad you're able to get multiple opinions. It seems like they are being thorough and taking good care of you.

I had a similar experience to Palesa in the sense that ovarian suppression has been okay for me. I've been on Zoladex for about seven months now. (I haven't started my AI yet because I've been on Xeloda, but I will soon.) So far my side effects are actually less than when I started Tamoxifen. I did well on Tamoxifen too, after an initial adjustment period. My oncology nurse practitioner once told me that often the effects of hormone medicine subside with time. I didn't believe her at first, but in retrospect that was my experience with both Tamoxifen and Zoladex.

Thanks for keeping us posted, and I'm wishing you the best.