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  • Review Article
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Latest biopsy approach for suspected metastases in patients with breast cancer

Nature Reviews Clinical Oncology volume 10, pages 711–719 (2013)Cite this article

Subjects

Key Points

  • Biopsies of suspected breast cancer metastases are not always performed in routine clinical practice owing to the cost and invasiveness of the procedure

  • Percutaneous image-guided biopsy is a safe, simple low-cost technique to obtain biopsy material from suspected metastases

  • Biopsies should be performed to determine oestrogen receptor, progesterone receptor or HER2 status of the lesion, particularly if the status of the primary tumour is unknown

  • Discordance between biomarker status in primary and secondary tumours can occur; however, standardized protocols might prevent discordance that results from technical errors

  • Increasing the numbers of biopsies performed throughout the disease trajectory will provide material for biobanks, aid future research, and might lead to innovative targeted therapies for breast cancer

Abstract

Biopsy of suspected metastases in patients with breast cancer is recommended in the practice guidelines of the National Comprehensive Cancer Network, but not always performed in routine oncology practice, often because of the cost and invasiveness of the procedure. Biopsies can confirm the presence of metastatic disease, reveal unsuspected benign disease or second (non-breast) malignancies and confirm expression of biomarkers, all of which can aid the optimal management of the cancer. Image-guided biopsy has increased the accuracy and safety of the procedure. Here, we aim to provide a practical algorithm for deciding when to perform biopsy of suspected breast cancer metastases, in order to optimize clinical practice. We expect that future clinical trials and standard-of-care practice will increasingly obtain tissue from metastases to assess molecular differences (DNA, RNA, protein) between the primary tumour and metastases. Advances in targeted therapy for breast cancer will be highly dependent on the availability of metastatic tissue. In this article, we provide an up-to-date review of the current issues in biopsy of suspected metastases in patients with breast cancer, including technical details of biopsy, pathology review of biopsy specimens, and interpretation of biopsy findings.

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Figure 1: A CT-guided biopsy of the left iliac bone.
Figure 2: An ultrasonography-guided biopsy of the liver.
Figure 3
Figure 4

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Acknowledgements

N. Niikura was supported in part by the MEXT-Supported Program for the Strategic Research Foundation at Private Universities. We thank S. Deming, Scientific Publications, MD Anderson Cancer Center, for editorial assistance.

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Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, 259-1193, Kanagawa, Japan

    Naoki Niikura & Yutaka Tokuda

  2. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, 77030, TX, USA

    Bruno C. Odisio

  3. Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, 77030, TX, USA

    Fraser W. Symmans

  4. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, 77030, TX, USA

    Gabriel N. Hortobagyi

  5. Section of Translational Breast Cancer Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, 77030, TX, USA

    Naoto T. Ueno

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Contributions

N. Niikura, B. C. Odisio, F. W. Symmans and N. T. Ueno researched data for the article. All authors wrote the article, made substantial contribution to discussion of the content and reviewed/edited the manuscript before submission.

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Correspondence to Naoto T. Ueno.

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Competing interests

N. T. Ueno receives grant funding from ApoCell Inc. The other authors declare no competing interests.

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Niikura, N., Odisio, B., Tokuda, Y. et al. Latest biopsy approach for suspected metastases in patients with breast cancer. Nat Rev Clin Oncol 10, 711–719 (2013). https://doi.org/10.1038/nrclinonc.2013.182

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