Can FNA or Core Biopsy Spread Cancer Cells?

Question: Do needle-core biopsies spread or “seed” cancer cells? I have two references at least that address this one in archives of surgery: medical journal on issue of needle core biopsies spreading cancer cells: Manipulation of the Primary Breast Tumor and the Incidence of Sentinel Node Metastases From Invasive Breast Cancer spreading cancer cells: Nora M. Hansen, MD; Xing Ye, MS; Baiba J. Grube, MD; Armando E. Giuliano, MD Arch Surg. 2004;139(6):634-640. doi:10.1001/archsurg.139.6.634. John Wayne Cancer Institute and another that references other research as well: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883438/ Someone who reads frequent pathology reports reads reports after lumpectomies referring to removing these “seeds” and buddings along needle track. My surgeon says she’s done 100s of breast surgeries and has never heard of or seen this.

Answer: There are rare reports of supposed “spreading” of cancer cells following FNA or core needle biopsy.  I’ve read them and in 17 years of practice I’ve never encountered a breast care specialist who believes that doing a core biopsy is going to spread a cancer. I would agree with your surgeon on this one. I’m sure you’ve read these journal articles but notice in the Conclusion sections, particularly in the Hansen paper, they say that they don’t know the clinical significance of this phenomenon. In the Cho paper, they say there was no difference in local recurrence rates between patients undergoing core biopsy vs. excisional biopsy and no overall survival difference in patients who had a pre-op core biopsy.  The issue here is displacing cancer cells based on procedure (core/FNA/excisional biopsy). All of these procedures can theoretically displace cancer cells. The issue is biology. Just because those cells have been displaced to the skin or the lymph nodes because of a procedure doesn’t mean they have metastatic potential and can grow and spread. The biology of metastatic cancer lies in the genetics of the cell, not whether the doctor moves that cell to another part of the body inadvertently by a medical procedure. I hope this helps. In my opinion, I would not allow any friend of mine to forgo a breast core biopsy based on these fears of spread that really have not been well-substantiated.

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  1. Babbles from Ohio

    My doctor spent two hours going over my biopsy done July 26 with my husband present. She explained the next step would be submitting my case before a group of cancer specialists on the following Thursday. So on August 1, we traveled home with the highest hopes. After all we had gone eighty miles from our residence to make sure we had the best doctors the medical world had to offer, and we felt blessed that our surgeon was not only the best in her field, but she had a wonderful presence about her giving off confidence, trust and hope. Before we left her office she encouraged us to make an appointment ten days later ( the first Tuesday following next Thursdays conference with the other oncologists) and we did. It had been a whole twenty four hours after the conference and I used the excuse of confirming my upcoming Tuesday appointment to try and get any tidbit of new information about my case. To my surprise, I was informed my appointment had been canceled since I had already had my after surgery appointment early, and my case had not been submitted for review last Thursday. When I inquired as to why not I was told that all the information needed in my file had not been collected yet. Feeling this was an error I wanted to know what specifically was missing. The young lady on the other end of the phone stammered around with several reasons ” the pathology report , the cat scans and this happens all the time”. I then informed her that could not be the reason as our doctor read to us from my pathology report, and she pursued the issue by explaining how long it takes the pathology staff to analyze the specimen . First, she says it must be dissected, stained,and … I interrupted and reminded her that we seen the completed report. Ending that conversation I asked for my doctor who was in surgery, but was able to talk to a nurse practitioner . I learned from that conversation that the young lady I just spoke with was a temp for the vacationing assistant and I figured out that this person who held my very life in her hands had in fact done nothing to facilitate my case so that it could be discussed, and with two types of cancer ( one of a more aggressive and malignant nature) I must wait, wait, wait yet another week to learn what the doctors have settled upon as my course of treatment. This cancer was first suspected in May. It is now the middle of August, and I am yet to receive any treatment of any kind what so ever. Should I continue to seek treatment at this highly rated hospital system? Should I go elsewhere? Thank you for your time. When you answer…please forward a copy of my question and your answer to my email address. Thank you.

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