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

Qing Qu,Xiao-Chun Fei,Cheng Xu,Yu Zong,Xiao-Song Chen,Kun-Wei Shen,Gu-Yin Lou

doi:10.1186/1477-7819-12-93

Qing Qu, Xiao-Chun Fei + Show 5 more

Open Access

https://doi.org/10.1186/1477-7819-12-93

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Abstract

BackgroundReceptor 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.MethodsSixty-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).ResultsA 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.ConclusionsThe 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.

Highlights

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
Patients who met the following criteria were considered for further analysis: (1) primary breast cancer totally resected, (2) metachronous lesions with suspected metastasis detected by physical examination, ultrasound or computed tomography (CT) without evidence of primary tumor recurrence, (3) multidisciplinary decision for biopsy by surgeons, medical oncologists, radiation therapists, radiologists and pathologists, and (4) complete clinical and follow-up data
The breast cancer subtypes defined by ER, PR, and HER2 are helpful to direct treatment and choose endocrine therapy, molecular-targeted therapy and cytotoxic chemotherapy

Summary

Introduction

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. Breast cancer is the most common malignancy affecting women in developed countries. Breast cancer patients with early stage disease can be cured, more than 20% of these patients will eventually develop incurable metastatic disease [2,3]. The rates of disease-free survival and the overall survival have increased over the years, largely because adjuvant therapy (chemotherapy, radiation therapy or hormone therapy), has helped prevent local and distant failures. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are important indicators to determine the prognosis of patients with breast cancer.

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