New Findings on Biopsies for Breast Cancer

Data from three new studies may alter clinical practice in diagnosing breast cancer and determining whether it has spread. The studies were presented at a forum of researchers from the US Department of Defense Breast Cancer Research Program (BCRP, Fort Detrick, MD, USA) held in Orlando, FL (USA).

Diagnosis without surgery
A new technique called magnetic resonance spectroscopy (MRS) analyzes chemicals present in a small cluster of breast cells removed with a fine needle. If a malignancy is found, a computer program evaluates the likelihood that the tumor has spread to the lymph nodes. Laboratory tests have shown that MRS can identify benign and malignant tumors and the presence or absence of lymph node involvement with a high degree of accuracy. In women with early breast cancer, lymph node involvement is a crucial factor in determining how their disease is treated. However, surgical removal of lymph nodes can cause lymphedema. This swelling due to excess fluid accumulation remains a risk after the procedure and after the cancer has been successfully treated.

Less-invasive biopsy
New data support expanding the pool of women with breast cancer for whom sentinel node biopsy (SNB) is appropriate. This method requires examination of only one or two lymph nodes and thereby avoids the risk of lymphedema and its complications.

"The sentinel node will not accurately reflect the other lymph nodes in less than 1% of patients, and it's clear that SNB will be both more accurate and less traumatic than the axillary node procedure for the vast majority of patients,” said Lorraine Tafra, M.D., director of the Breast Center at the Anne Arundel Medical Center in Annapolis (MD, USA).

Furthermore, the study found that the technique used to analyze the SNB tissue can influence the results. When specimens were examined with a molecular test, RT-PCR (reverse transcription polymerase chain reaction), tumor cells were detected in 61% of 36 false-negative patients. Also, tissue for RT-PCR was sampled throughout the sentinel node, while pathologists usually are able to examine only a few central sections.

Lumpectomy without nodal biopsy
Older women who have breast-conserving surgery (BCS, or lumpectomy) without lymph node biopsy or radiation therapy have poorer survival rates than those who have this procedure plus biopsy. Nodal biopsy was strongly associated with higher seven-year survival rates and higher rates of post-surgical radiation or chemotherapy.

"Survival of older breast cancer patients hasn't improved for 20 years. Our study suggests that one key reason may be the growing popularity of BCS for early-stage disease without nodal dissection, which can lead to under-staging and under-treatment, ultimately leading to higher recurrence and higher mortality,” said Xianglin Du, M.D., Ph.D., of the University of Texas Medical Branch and Sealy Center on Aging (Galveston, TX, USA).




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US Army BC Program