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World Journal of Surgical Oncology

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Open Access 01-12-2014 | Research

The importance of biopsy in clinically diagnosed metastatic lesions in patients with breast cancer

Authors: Qing Qu, Yu Zong, Xiao-chun Fei, Xiao-song Chen, Cheng Xu, Gu-yin Lou, Kun-wei Shen

Published in: World Journal of Surgical Oncology | Issue 1/2014

Abstract

Background

Receptor status discordance, such as estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancer and metastatic lesions has been reported. The aim of this study was to evaluate the biopsy of clinically diagnosed metastatic lesions and to determine the changes in hormonal receptor and HER2 status of the metastatic lesions.

Methods

Sixty-three patients with clinically diagnosed metastatic breast cancer underwent an excisional biopsy or core needle aspiration guided by computed tomography/ultrasound. ER, PR and HER2 were assessed by immunohistochemistry (IHC).

Results

A total of 48 metastases (76.2%) and nine second primary malignancies (14.3%, seven primary lung cancers and two primary pancreatic cancers) were found. The discrepancies between ER, PR and HER2 status between the primary breast cancer and metastatic lesions were 14.6%, 16.7% and 8.3%, respectively. Six lesions (9.5%) were proved benign upon biopsy.

Conclusions

The biopsy of clinically suspicious metastatic lesions could histologically confirm the diagnosis of metastasis, evaluate discrepancies between ER, PR and HER2 status and exclude secondary malignancy, which might change the therapeutic strategy for breast cancer patients.

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Linos E, Spanos D, Rosner BA, Linos K, Hesketh T, Qu JD, Gao YT, Zheng W, Colditz GA: Effects of reproductive and demographic changes on breast cancer incidence in China: a modeling analysis. J Natl Cancer Inst. 2008, 100: 1352-1360. 10.1093/jnci/djn305.PubMedCentralCrossRefPubMed

Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JD, Feuer EJ: Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005, 353: 1784-1792. 10.1056/NEJMoa050518.CrossRefPubMed

Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005, 365: 1687-1717.

Perou CM, Sorlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, Pollack JR, Ross DT, Johnsen H, Akslen LA, Fluge O, Pergamenschikov A, Williams C, Zhu SX, Lønning PE, Børresen-Dale AL, Brown PO, Botstein D: Molecular portraits of human breast tumours. Nature. 2000, 406: 747-752. 10.1038/35021093.CrossRefPubMed

Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Lønning PE, Børresen-Dale AL: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 2001, 98: 10869-10874. 10.1073/pnas.191367098.PubMedCentralCrossRefPubMed

Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, Demeter J, Perou CM, Lønning PE, Brown PO, Børresen-Dale AL, Botstein D: Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci U S A. 2003, 100: 8418-8423. 10.1073/pnas.0932692100.PubMedCentralCrossRefPubMed

McDermott SP, Wicha MS: Targeting breast cancer stem cells. Mol Oncol. 2010, 4: 404-419. 10.1016/j.molonc.2010.06.005.PubMedCentralCrossRefPubMed

Amir E, Clemons M: Should a biopsy be recommended to confirm metastatic disease in women with breast cancer?. Lancet Oncol. 2009, 10: 933-935. 10.1016/S1470-2045(09)70295-5.CrossRefPubMed

Gutierrez MC, Detre S, Johnston S, Mohsin SK, Shou J, Allred DC, Schiff R, Osborne CK, Dowsett M: Molecular changes in tamoxifen-resistant breast cancer: relationship between estrogen receptor, HER2, and p38 mitogen-activated protein kinase. J Clin Oncol. 2005, 23: 2469-2476. 10.1200/JCO.2005.01.172.CrossRefPubMed

10.

Johnston SR, Saccani-Jotti G, Smith IE, Salter J, Newby J, Coppen M, Ebbs SR, Dowsett M: Changes in estrogen receptor, progesterone receptor, and pS2 expression in tamoxifen-resistant human breast cancer. Cancer Res. 1995, 55: 3331-3338.PubMed

11.

Simmons C, Miller N, Geddie W, Gianfelice D, Oldfield M, Dranitsaris G, Clemons MJ: Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?. Ann Oncol. 2009, 20: 1499-1504. 10.1093/annonc/mdp028.PubMedCentralCrossRefPubMed

12.

Kuukasjarvi T, Kononen J, Helin H, Holli K, Isola J: Loss of estrogen receptor in recurrent breast cancer is associated with poor response to endocrine therapy. J Clin Oncol. 1996, 14: 2584-2589.PubMed

13.

Gancberg D, Di Leo A, Cardoso F, Rouas G, Pedrocchi M, Paesmans M, Verhest A, Bernard-Marty C, Piccart MJ, Larsimont D: Comparison of HER2 status between primary breast cancer and corresponding distant metastatic sites. Ann Oncol. 2002, 13: 1036-1043. 10.1093/annonc/mdf252.CrossRefPubMed

14.

Hao XS, Chen KS, Liu H: Analysis of female breast cancer descriptive epidemiology in Tianjin, China. Asian Pac J Cancer Prev. 2002, 3: 143-148.PubMed

15.

Broom RJ, Tang PA, Simmons C, Bordeleau L, Mulligan AM, O’Malley FP, Miller N, Andrulis IL, Brenner DM, Clemons MJ: Changes in estrogen receptor, progesterone receptor and HER2/neu status with time: discordance rates between primary and metastatic breast cancer. Anticancer Res. 2009, 29: 1557-1562.PubMed

16.

Zidan J, Dashkovsky I, Stayerman C, Basher W, Cozacov C, Hadary A: Comparison of HER2 overexpression in primary breast cancer and metastatic sites and its effect on biological targeting therapy of metastatic disease. Br J Cancer. 2005, 93: 552-556. 10.1038/sj.bjc.6602738.PubMedCentralCrossRefPubMed

17.

Jensen JD, Knoop A, Ewertz M, Laenkholm AV: ER, HER2, and TOP2A expression in primary tumor, synchronous axillary nodes, and asynchronous metastases in breast cancer. Breast Cancer Res Treat. 2012, 132: 511-521. 10.1007/s10549-011-1610-3.CrossRefPubMed

18.

Liu J, Deng H, Jia W, Zeng Y, Rao N, Li S, Jin L, Wu J, Song E, Su F: Comparison of ER/PR and HER2 statuses in primary and paired liver metastatic sites of breast carcinoma in patients with or without treatment. J Cancer Res Clin Oncol. 2012, 138: 837-842. 10.1007/s00432-012-1150-1.CrossRefPubMed

19.

Lindstrom LS, Karlsson E, Wilking UM, Johansson U, Hartman J, Lidbrink EK, Hatschek T, Skoog L, Bergh J: Clinically used breast cancer markers such as estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 are unstable throughout tumor progression. J Clin Oncol. 2012, 30: 2601-2608. 10.1200/JCO.2011.37.2482.CrossRefPubMed

20.

Hoefnagel LD, Moelans CB, Meijer SL, van Slooten HJ, Wesseling P, Wesseling J, Westenend PJ, Bart J, Seldenrijk CA, Nagtegaal ID, Oudejans J, van der Valk P, van Gils CH, van der Wall E, van Diest PJ: Prognostic value of estrogen receptor alpha and progesterone receptor conversion in distant breast cancer metastases. Cancer. 2012, 118: 4929-4935. 10.1002/cncr.27518.CrossRefPubMed

21.

Gong Y, Booser DJ, Sneige N: Comparison of HER2 status determined by fluorescence in situ hybridization in primary and metastatic breast carcinoma. Cancer. 2005, 103: 1763-1769. 10.1002/cncr.20987.CrossRefPubMed

22.

Liedtke C, Broglio K, Moulder S, Hsu L, Kau SW, Symmans WF, Albarracin C, Meric-Bernstam F, Woodward W, Theriault RL, Kiesel L, Hortobagyi GN, Pusztai L, Gonzalez-Angulo AM: Prognostic impact of discordance between triple-receptor measurements in primary and recurrent breast cancer. Ann Oncol. 2009, 20: 1953-1958. 10.1093/annonc/mdp263.PubMedCentralCrossRefPubMed

23.

Thompson AM, Jordan LB, Quinlan P, Anderson E, Skene A, Dewar JA, Purdie CA: Prospective comparison of switches in biomarker status between primary and recurrent breast cancer: the Breast Recurrence In Tissues Study (BRITS). Breast Cancer Res. 2010, 12: R92-10.1186/bcr2771.PubMedCentralCrossRefPubMed

24.

Fidler IJ, Kripke ML: Metastasis results from preexisting variant cells within a malignant tumor. Science. 1977, 197: 893-895. 10.1126/science.887927.CrossRefPubMed

25.

Chambers AF, Groom AC, MacDonald IC: Dissemination and growth of cancer cells in metastatic sites. Nat Rev Cancer. 2002, 2: 563-572. 10.1038/nrc865.CrossRefPubMed

26.

Hawkins RA, Tesdale AL, Anderson ED, Levack PA, Chetty U, Forrest AP: Does the oestrogen receptor concentration of a breast cancer change during systemic therapy?. Br J Cancer. 1990, 61: 877-880. 10.1038/bjc.1990.196.PubMedCentralCrossRefPubMed

27.

Pusztai L, Viale G, Kelly CM, Hudis CA: Estrogen and HER2 receptor discordance between primary breast cancer and metastasis. Oncologist. 2010, 15: 1164-1168. 10.1634/theoncologist.2010-0059.PubMedCentralCrossRefPubMed

28.

Foukakis T, Astrom G, Lindstrom L, Hatschek T, Bergh J: When to order a biopsy to characterise a metastatic relapse in breast cancer. Ann Oncol. 2012, 23 (Suppl 10): x349-x353. 10.1093/annonc/mds297.CrossRefPubMed

29.

Brown LM, Chen BE, Pfeiffer RM, Schairer C, Hall P, Storm H, Pukkala E, Langmark F, Kaijser M, Andersson M, Joensuu H, Fosså SD, Travis LB: Risk of second non-hematological malignancies among 376,825 breast cancer survivors. Breast Cancer Res Treat. 2007, 106: 439-451. 10.1007/s10549-007-9509-8.CrossRefPubMed

30.

Kirova YM, De Rycke Y, Gambotti L, Pierga JY, Asselain B, Fourquet A: Second malignancies after breast cancer: the impact of different treatment modalities. Br J Cancer. 2008, 98: 870-874. 10.1038/sj.bjc.6604241.PubMedCentralCrossRefPubMed

31.

Shilkrut M, Belkacemi Y, Kuten A: Secondary malignancies in survivors of breast cancer: how to overcome the risk. Crit Rev Oncol Hematol. 2012, 84 (Suppl 1): e86-e89.CrossRefPubMed

32.

Vidal-Millan S, Zeichner-Gancz I, Flores-Estrada D, Vela-Rodriguez BE, Vazquez-Lopez MI, Robles-Vidal CD, Ramirez-Ugalde MT, Chavez-MacGregor M: A descriptive study of second primary malignancies associated to breast cancer in a Mexican Hispanic population. Med Oncol. 2005, 22: 17-22. 10.1385/MO:22:1:017.CrossRefPubMed

33.

Rena O, Papalia E, Ruffini E, Filosso PL, Oliaro A, Maggi G, Casadio C: The role of surgery in the management of solitary pulmonary nodule in breast cancer patients. Eur J Surg Oncol. 2007, 33: 546-550. 10.1016/j.ejso.2006.12.015.CrossRefPubMed

34.

Lee KD, Chen SC, Chan CH, Lu CH, Chen CC, Lin JT, Chen MF, Huang SH, Yeh CM, Chen MC: Increased risk for second primary malignancies in women with breast cancer diagnosed at young age: a population-based study in Taiwan. Cancer Epidemiol Biomarkers Prev. 2008, 17: 2647-2655. 10.1158/1055-9965.EPI-08-0109.CrossRefPubMed

35.

Trentham-Dietz A, Newcomb PA, Nichols HB, Hampton JM: Breast cancer risk factors and second primary malignancies among women with breast cancer. Breast Cancer Res Treat. 2007, 105: 195-207. 10.1007/s10549-006-9446-y.CrossRefPubMed

36.

Prochazka M, Hall P, Granath F, Czene K: Family history of breast cancer and young age at diagnosis of breast cancer increase risk of second primary malignancies in women: a population-based cohort study. Br J Cancer. 2006, 95: 1291-1295. 10.1038/sj.bjc.6603404.PubMedCentralCrossRefPubMed

Title: The importance of biopsy in clinically diagnosed metastatic lesions in patients with breast cancer
Authors: Qing Qu
Yu Zong
Xiao-chun Fei
Xiao-song Chen
Cheng Xu
Gu-yin Lou
Kun-wei Shen
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2014
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-12-93

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The importance of biopsy in clinically diagnosed metastatic lesions in patients with breast cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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