Can biopsies cause cancer to spread?
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This from a 2011 abstract:
Needle biopsy of the breast is widely practised. Image guidance ensures a high degree of accuracy. However, sporadic cases of disease recurrence suggest that in some cases the procedure itself may contribute to this complication. This article reviews evidence relating to needle biopsy of the breast and the potential for tumour cell migration into adjacent tissues following the procedure. A literature search was undertaken using Medline, Embase and the Cochrane Library. Results are grouped under three categories: histological evidence of spread, clinical evidence of recurrent disease and the likelihood of seeding dependent upon tumour type.
There is histological evidence of seeding of tumour cells from the primary neoplastic site into adjacent breast tissue following biopsy. However, as the interval between biopsy and surgery lengthens then the incidence of seeding declines, which suggests that displaced tumour cells are not viable. Clinical recurrence at the site of a needle biopsy is uncommon and the relationship between biopsy and later recurrence is difficult to confirm.
There is some evidence to suggest that cell seeding may be reduced when vacuum biopsy devices are deployed. http://www.ncbi.nlm.nih.gov/pubmed/21933978 (emphasis mine)
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I was initially diagnosed 2/14/08, and had a needle biopsy on that date. Soon after I had a bilateral mastectomy with reconstruction. The initial tumor was .4cm, and there was no node involvement. No other treatment was required. I visited my surgeon's office less than a year later complaining of a return of a dimple. I had had a dimple before the initial surgery. My BS was not available, I had to see the NP. She told me the dimple was just cosmetic and that I could get liposuction from the PS.
I never went back to the BS until 4 years later when I found a 1 cm lump where the dimple had been. The lump was just on the outside edge of my implant and directly above the original tumor, but on the skin. I had the tumor removed, 5 weeks of radiation, and am now on Tamoxifen. I had a PET scan at that time and nothing significant was found.
My BS met with a panel to discuss my case. He told me the consensus was that the cell was deposited during the original biopsy. My BS has worked with 37,000 patients, and never seen this before. I do recall that the radiologist gave me two jabs to get the biopsy. They said I moved the first time. I had quite a hematoma following that biopsy. It is almost a year ago that this recurrrance was discovered. My internist wants me to get another PET scan in March.
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was sitting and thinking, then panicked. Surely a biopsy would spread the cells!
I have to wait 4 weeks for surgery, skin replaces in 7 srven days, so what does that mean for loose rampant cells?
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Hi
I read research about doing CNBs with papilloma, and it stated not doing biopsies as the cells would spread. Basically, that would mean to push to eat TAmoxifen or relevant drug during lumpectomry for large tumor.
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Here is an excerpt to this page
Should you worry about this? The short answer is no. Let me explain.
The risk of “seeding the tract” is theoretical. It has never been proven in a strong, reliable, scientific breast cancer study. For sure, almost anything is possible and it is considered prudent by surgeons to use the shortest needle tract possible to get to the tumor for biopsy in order to lower this theoretical risk and to decrease the risk of other complications as well. But there is no reliable evidence that “seeding the tract” actually happens.
Can a biopsy turn DCIS into an invasive cancer?
Here too, the answer is no. Normal cells turn into DCIS, which then turn into invasive cancer by a process known as tumorigenesis. This is a complex, molecular change that occurs over many years and is not affected by a biopsy.
The only way to completely eliminate this theoretical risk would be to perform a mastectomy, where the entire needle tract (and breast) is removed. We know that women who have breast-conserving surgery with radiation (where the needle tract is mostly left in) do just as well as women who have mastectomy in terms of the cancer coming back. If the needle-tract risk was something to worry about (real or not), women with breast-conserving treatment would do worse — but this is not the case.
I care for patients with breast cancer every day. The amount of anxiety they are subject to is overwhelming. There are many real concerns for women that will impact their chance of being cured: getting the right diagnosis and treatment, side effect management, financial security, and follow-up. But there is no solid evidence that biopsies can cause breast cancer to spread, and that’s one less thing to worry about.
Here is also info on SNB:
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Mods,
Thank you for that wonderfully clear post! I think the most salient point you make is that seeding is theoretically possible. In theory all kinds of things are possible but the jump to reality is far less likely. In this case, the reality of seeding has not been shown to occur.
Ladies, a dx of bc gives us enough to worry about , let's not make seeding one of those worries!
Caryn0 -
Well, I still think it happened to me. I had a core biopsy (negative), 5 years ago, in the exact area where IDC was finally found. It was a very sluggish, Grade 1, no LVI, low Ki67 score tumor. Yet 2 lymph nodes had micromets. I think that original, wrong biopsy spread some cells which made it to my nodes. I don't see how the cells could have gotten there otherwise. Does that mean I think we shouldn't have biopsies? Absolutely not. I just believe it is one of the risks out there. Leaving cancer in because it has not been biopsied is obviously MUCH worse.
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Yorkiemom, my guess of what might have happened in your situation is that the original biopsy missed the area of cancer, so it presented a false negative. If the needle didn't hit the cancer (which is what a negative biopsy would suggest), then it couldn't have caused seeding because cancer cells never got onto or into the needle. But if the cancer was in your breast at that time, it means that it was there for a least 5 more years before it was found. So it's very possible that some cells from the small area of cancer might have worked their way to your nodes - even grade 1 cancer sometimes is node positive.
Seeding happens when cancer cells have been left behind by the needle, in the needle tract or somewhere where the needle has been. If your biopsy needle didn't hit the area of cancer, and if the biopsy needle (with cancer cells on it) didn't touch your nodes (and drop the cancer cells there by accident), then there can't be seeding.
The other possibility is that your nodes were seeded, but this could only have happened at the time of your surgery 5 years later. If the surgical instrument that was used to remove your breast tumor was also used to remove the nodes, then it could have contaminated the nodes, leaving behind some cancer cells. That happens sometimes with DCIS cells. DCIS cells cannot travel to the nodes on their own, but sometimes when an SNB is done, isolated tumor cells (DCIS cells) are found in the nodes. That is obvious contamination/seeding. In your case, however, I'd guess that it was the 5 years that the cancer was in your breast that allowed a few of those cancer cells to take their time and work their way up into the nodes.
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That makes sense Beesie. It is possible that is what happened. One thing, though, it was 3 years between biopsies. I'm including the 2 years after my second biopsy, which gets me to the present. Just seems weird that such a sluggish cancer would have made it to my nodes without some "help." But I will never know, and obviously the research does not back up my suspicions.
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Grade 1 cancers can also present with a high oncotype score (as grade 3 can have a low oncotype score). Grade and size alone do not guarantee no nodal involment. And that goes for a low Ki67 as well. The genetic variants of a tumor can allow for anything to happen given the right conditions. There are sisters here who had small grade 1 cancers turn into mets...despite treatment. Cancer is a strange disease and very oriented to specific biological behaviors of the person who has it...your genetic makeup.
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I asked my BS nurse about this very thing on Friday, she said no. Well, since I'm DCIS according to the biopsy, but there might be a chance that they find something else (MI or DCI or?) when they get in there for the lumpectomy....this really concerns me. Should I insist on a removal of the biopsy track line?0 -
Yes, it's possible that your final diagnosis might include some IDC. But if the biopsy needle didn't pull up any invasive cancer cells, then it couldn't have tracked any invasive cancer cells. If a microinvasion is found during your surgery hidden in with the DCIS, it obviously will be in a different area than where the biopsy needle went - since it wasn't found during the biopsy.
Are you planning to have rads? Even for those with invasive cancer, rads is usually what's done to address this tiny tiny risk.0 -
If I had to do it all over again, I'd go with the excisional biopsy. I wouldn't care if they cut me open, and it turned out to be benign. If you poke at something that's filled with "stuff," then "stuff" may come out. I advise others who have asked me to do the same.
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GlobalGirlyGirl, think about it.... if you cut something open that is filled with stuff, isn't that more likely to cause the stuff to come out than just a small needle poke? So often I've read posts from women saying that they would prefer to have a surgical biopsy rather than a needle biopsy in order to reduce the risk of seeding, and honestly, it just doesn't make sense to me. If there is a concern about seeding, isn't it worse to have a surgical instrument (possibly contaminated with cancer cells) poking around within the tissue? Isn't it worse to have all those cut open ducts and all that breast tissue cut into, sometimes right through the area of cancer? A few needle pricks seems to me to present the least risk of contamination and seeding.
That's not to say that I think that excisional biopsies and surgery present much of a risk. I had an excisional biopsy for calcifications that were found in two areas of my breast. The results uncovered high grade DCIS throughout, along with a microinvasion of IDC, and there were no clear margins anywhere. I had a MX 2 1/2 months later. With all those ducts cut open and all those very aggressive DCIS cells right at the edge of all those ducts, ready to spill out into my breast tissue, how is it that my final pathology from my MX showed lots more high grade DCIS but no invasive cancer? So I just don't think the risk of seeding - whether from a needle biopsy or a surgical biopsy, or from surgery - is something to worry about.0 -
globalgirly,
Did you read the link the mods posted on 9/15 regarding seeding? Seeding is possible, in theory but thus far little to no evidence exists that it actually happens.0 -
Bessie - Sure...if they only take a chunk of it. If they took all of it with a margin, that wouldn't be a problem. I'd prefer that. If it turned out to be benign, then yay! Plus, it's not like I wanted the tumor to begin with - benign or malignant. Taking the whole thing out would be a win win for me.
exbrnxgrl - The fact that it is even theoretically possible is enough for me to not to consent to it. I wish I knew all that before, especially if I knew about BI-RADS. I'd ask the radiologist if they thought it was a 4 or 5. Mine was a 5. 95% chance of malignancy. If it were, I'd ask for excisional (total removal with a margin). Unfortunately, my mammogram, ultrasound, and biopsy were all in one day. Coulda woulda shoulda. I can't change the past.
The article talks about it being one less thing to worry about. Sorry, but for me, it's one more. I was lucky enough to get cancer. I wouldn't be surprised if I were lucky enough to be the first case. Ugh.
Hope for the best, I guess.0 -
sorry the article didn't ease your mind. I can be a bit of a worrier but I'm learning not to borrow trouble.0 -
GlobalGirlyGirl,
An excisional biopsy means taking the whole suspicious area. But since cancer cells are microscopic, it's impossible for a surgeon to know, as he or she is operating, if there are clean margins or not. No responsible surgeon is going to take out a much larger chunk of breast tissue than necessary when the odds are that the biopsy will be benign (a BIRADs 4, particularly 4A and 4B). My surgeon certainly didn't intend to leave behind all those dirty margins; he removed a lot of tissue - the entire area that showed up as suspicious on my mammogram. It's just happened that there was a lot more cancer in my breast than what the imaging showed. That's not all that unusual.
The problem with having an excisional biopsy when it's not indicated is that the surgery itself leaves scar tissue than can impact future screenings and can also result in the development of calcifications and fatty necrosis sometime down the road. So one unnecessary surgical biopsy often leads to more unnecessary biopsies. It's just not medically responsible to do that when the risk that cancer will be found in the biopsy is low.
Consider that in 2013, it's estimated that 297,000 women in the U.S. will be diagnosed with either invasive cancer or DCIS. It's also known that 80% of biopsies are benign. So this means that almost 1.5 million women will undergo a biopsy this year, and approx. 1.2 million of those biopsies will be benign. A portion of those women - maybe 20% to 25% - will have excisional biopsies but most will have core needle or vacuum assist needle biopsies. Do we seriously want to send close to an extra 1 million women into surgery each year, for what will turn out to be no reason at all?
Having had more FNAs than I can remember, 3 core needle biopsies (two stereotactic and one ultrasound guided), and 3 excisional biopsies, I will alway opt for the lesser biopsy first. And I will always advise the same to anyone else. Why put someone onto a biopsy treadmill for no reason? And why expose someone to the risks of surgery if it's not necessary? The known risks of surgery are greater than the theoretical risks of seeding.
The one exception I'd make is if I (or someone else I was advising) had a BIRADs 5. Because the risk of cancer is 95%, usually if a needle biopsy result is benign (and therefore discordant with the imaging), the breast surgeon or radiologist will recommend an excisional biopsy anyway, in order to ensure that the needle biopsy result was correct. So someone who has BIRADs 5 imaging is almost certain to end up in surgery, one way or the other. Given that, with a BIRADs 5, I agree that it probably makes sense to skip the step of doing the needle biopsy. But I don't say that because of any concern about seeding; I say that so that the patient can avoid an extra procedure.0 -
Thank you, Beesie. It is important to point out the risks that a surgical biopsy poses, that are known, as opposed to the theoretical risk of seeding. But, as we all know, fears often trump what is rational.0 -
All good exbrnxgrl.
Thanks for the further clarification Bessie. That's why if I had to do it all over again and knew I was BIRADS 5, I would have chosen the excisional.0 -
So this article says yes but the risk is very, very low.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3473763/
However if you are having a biopsy maybe start Loratidine beforehand, which is OTC and widely available. I would have if I had read this prior to my biopsy.
http://www.canceractive.com/cancer-active-page-link.aspx?n=2981
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PNWskier - this thread has not been active since 2013 - however there are some really good points if anyone wants to go back and read the three pages of posts. Including an excellent post by the MODS.
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I think it may be plausible this happened to me. I had a biopsy done on a 2.5 cm lump 1/2014, that resulted as fibroepithelial lesion. No action was taken. It grew to 9cm and after another biopsy 10/2016 was diagnosed as fibroadenoma, again no action was going to be taken until finally I was referred to breast surgeon. Only after it was excised it was found to be a large phyllodes with multifocal, grade 3 IDC and DCIS. I am considered stage 1A due to the largest tumor being 1.8 cm and 0/2 node negative, and being treated as such even though the cancer burden I feel is much higher. I can't shake this feeling that without a CT or PET (they used to give this to everyone) I can't really confirm it hasn't spread. And now it's even been recommended that I skip hormone therapy, when I'm ER+, PR+, and HER2+.
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Tiny, just keep pressing your physician. I empathize with your feelings of worry and concern. I don't believe biopsies can cause cancer; I do think that unless they are excised completely, they can spread once the tumor is opened even in a very small space. Maybe your tumor was not differentiated enough so as to be appropriately classified. I had a fibroadenoma before the IDC for a very long time. It took me approximately about five years. My fibroadenoma was very large and inside it was the small tumor.
The internet informs that phyllodes tumors ate mostly benign and malignant cases are rare. Maybe that's why they are not giving you treatment. Go to the phyllodes site or create a new one and connect with people with rare tumors. Check on a second opinion if you need too but get yourself calm and relaxed.
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I agree needle core biopsies spread cancer cells. March 13th I had 2 needle core biopsies, I had Birads 5 in both breasts prior to the biopsies. I begged for excisional biopsies, but was not successful. I wanted a bilateral mastectomy. On March 13th, there was no palpable nor clinical (ultra sound) evidence of lymph involvement at this time. I was forced to have the needle core biopsies or I was not able to have treatment, one tumor had already grown .2 cm in just 13 days. No surgeon I could find, would do an excisional biopsy, or even treat my cancer without a needle core biopsy.
After the needle core biopsies by March 22, there was evidence of lymph involvement. This lymph-node tumor was larger than the rest of my tumors (2.6cm), it grew that big in 9 days. It was extra-nodal. I will never believe that this was NOT caused by the needle core biopsies. I am very afraid my cancer is systemic already. I have opted for chemo. I believe if they had removed my tumors intact, then went back in for the mastectomies, I would have been able to have my reconstruction and we would not be doing this chemo or the radiation therapy following the chemo. I would already be on my road to total recovery.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40151...
I hope this is helpful.
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Ugh, and now I'm reading from that link that multiple insertions of the biopsy needle are to be avoided as this can cause more seeding.
My BS went in at least twice to take samples...
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Yes, I noticed that line, too. Good point.
I remember asking my BS about it and she was quite clear in her opinion and experience that "seeding" wasn't an issue. I suppose time will tell, but even then, I'll never know for sure.
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I remember reading somewhere that an excisional (surgical) biopsy with good margins is the "gold standard" if you want to absolutely ensure that a potential malignancy won't be spread by the biopsy procedure. However, surgery is expensive and carries more risk than fine needle and stereotactic biopsies. So, unless you have a ton of cash to pay for one yourself, good luck getting any surgeon to do an excisional biopsy absent other circumstances (such as a failed needle biopsy, or lesion in an area that's hard to reach by needle).
I've had all kinds of biopsies (needle, stereotactic and surgical) and by far have preferred the surgical for the comfort of the procedure as well as the peace of mind (the whole thing is taken out, not just a sample). But, again, these days good luck finding a surgeon willing to do it. Insurers won't pay for it without special circumstances.0 -
I had excisional biopsy/lumpectomy with no previous biopsy. I was a birads 5 category so maybe that helped with insurance approval, but I had my approval in 24 hours from insurance, no issues at all. I told the surgeon to take a big chunk out, I want one and done if possible, and my surgeon took me at my word, 8 cm x 8 cm x 4 cm. for a 1.3 cm tumor. Now, two and a half years later, I have a slight ripple running across the side of my breast which does not bother me at all. My lump was at 2:00 left breast.
But in my case, they were 99% positive it was cancer, so there wasn't much debate. Other people have different experiences.
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