Can a needle aspiration make an in situ breast cancer invasive?

I've read that in situ breast cancer can become metastatic following a needle aspiration and I'm wondering if an in situ breast cancer can become invasive as a result of an aspiration and/or disruption due to surgery in the area without removing the tumor. Thanks!

Posted Answers

A:

Below are some articles I found on the subject:

FINE-NEEDLE ASPIRATION NOT SO FINE

When faced with the possibility of breast cancer, a decision as small as what type of biopsy you would like may seem unimportant. However, as two new studies show, the right decision can make a great difference to your health.

The first study, put together by the Radiologic Diagnostic Oncology Group, looked at the accuracy of fine-needle aspiration, a procedure that uses a thin, hollow needle to draw out tissue for examination. The conclusion? As many as one in three fine-needle aspiration biopsies failed to collect enough tissue to diagnose abnormalities. If not enough tissue is collected, the biopsy must be repeated.

Fine-needle aspiration is the least invasive type of biopsy available. It carries a low risk of infection and complications.

Etta Pisano, M.D., a cochair of the oncology group, says that while some facilities have experienced professionals that can perform fine-needle aspiration more accurately, most cannot. In a July 1, 1996, Internal Medicine News article, Pisano cautions women to find one of those experienced centers if they choose to undergo fine-needle aspiration.

Another minimally invasive option is core-needle biopsy, which is performed by inserting a tiny cutting instrument though a larger needle to collect tissue. This method removes more tissue than fine-needle aspiration. But while the larger sample reduces the need for repeat procedures, core-needle biopsies do not have a 100 percent accuracy rate for identifying cancer.

A study conducted at the Faulkner-Sagoff Breast Imaging Center found that core-needle biopsies guided by ultrasound--an imaging technique that uses sound to create a picture--were accurate in 71 percent of the cases. The accuracy rate dropped to 43.2 percent in stereotactically guided core-needle biopsies--biopsies in which a scanning device pinpoints the location of the abnormality and automatically guides the needle.

The researchers, who reported their results at the National Conference of the American College of Radiology, found that ultrasound guidance was better for women with larger masses and abnormalities, while the stereotactic guidance was better for breast calcifications--small deposits of calcium that may not show up using ultrasound technology.

If you or someone you know is about to undergo a biopsy for breast cancer, be sure to ask the practitioner about all of the options that are available. (There are other types of biopsies.) Examine the pros and cons of each option and ask about accuracy rates of both the procedures themselves and the facilities that perform them.


Today's top medical news and feel-better tips

Coming soon: new option for diagnosing breast cancer

It's called X-ray Guided Fine-Needle Aspiration (X-FNA), a breast-cancer-detection procedure complicated in name, but easy on the body. According to its developers, this new technique may be ideal for women under 50 who've had a mammogram showing a "mildly suspicious" lump--who want peace of mind without going through the rigors of surgical biopsy.

Recent studies involving 231 women at the University of Chicago show that surgical biopsy is still the most reliable option for confirming suspected breast cancer, with a 98 percent accuracy rate, as opposed to X-FNA's 91 percent. But since 80 percent of breast lumps screened early by mammography are noncancerous, the less accurate X-FNA could provide for low-riskers an alternative to a surgical biopsy--a costly and potentially scarring procedure that requires going in and extracting a small mass of lump from the breast.

X-FNA works like its predecessor, Fine-Needle Aspiration, except it has eyes. A needle is carefully injected into the breast using x-ray machinery to guide the doctor's hand. The doctor then extracts a minuscule portion of the lump. That's it.

With the x-ray giving the doctor a front-row seat inside the breast, precision increases over the hit-and-miss hand-guided FNA. And, unlike surgical biopsy, X-FNA does its work through a door the size of a pinprick.

It's quick, simple, inexpensive, nonscarring and as painless as a pinch.

Painless, but not perfect. According to one of the researchers, Robert A. Schmidt, M.D., assistant professor of radiology, with X-FNA's lower accuracy, patients should always follow up with a mammogram, an even simpler procedure involving x-rays taken of the breast from different angles. This may help to make sure nothing is missed.

Also, X-FNA's a tough appointment to make, since less than 100 X-FNA machines exist in the United States. But Dr. Schmidt hopes to see X-FNA's use expand and become available at larger institutions within the year. He also advises women to check with a radiologist at a local hospital for more information.

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By Greg Gutfeld


A generation ago, a breast biopsy usually meant general anesthesia and awakening to uncertainty. Because the standard practice for positive biopsies was immediate mastectomy, women were likely to receive the diagnosis by looking at their chests when they came to.

Medicine has come a long way since then. If you need a breast biopsy it will probably be done under local anesthesia, the sample will be analyzed, and the results relayed to you within a few days. If the tissue is malignant, you'll be informed of the available options for treatment and given time to think them over.

The accuracy of a biopsy depends on two things -- the quality of the tissue sample removed and the pathologist's analysis of that sample. In general, the more tissue removed during a biopsy, the lower the likelihood that cancer cells will escape unnoticed. At the same time, new techniques in molecular biology are making it possible to identify cancer cells and to determine their specific make-up in smaller and smaller samples.
When you'll need a biopsy

If you or your doctor finds a suspicious breast lump or if a routine mammogram turns up a suggestive abnormality, a biopsy will probably be recommended. Don't be alarmed if your primary-care doctor refers you to a surgeon; it doesn't mean that you need surgery, but only that a surgeon may be more experienced in determining the kind of biopsy you need and in performing it. The type of biopsy you undergo will depend largely on the type of lesion you have.
For breast lumps

Fine needle aspiration is the simplest type of biopsy for palpable lesions. The doctor anesthetizes the skin surrounding the lump and inserts a small needle into it. If the lump is a fluid-filled cyst, the doctor will extract the liquid. If the fluid is bloody it will be retained for analysis. Otherwise, the cyst will be considered benign.

If the lump is solid, the physician will work the needle in and out a few times to collect cells on the shaft and transfer them to a slide for the pathologist to read. This test can miss cancerous cells. Therefore, your doctor may suggest removing the entire lump if he or she thinks it could be malignant even if the pathologist's report is negative.

Core needle biopsy, in which a fatter needle is used to collect a larger sample of tissue from the center of a lump, predated fine-needle aspiration. It produces tissue samples that are easier for pathologists to read but is no more reliable than fine-needle aspiration in detecting cancer. It may cause greater discomfort because the doctor has to exert more pressure to get the sample. For that reason, core biopsy is used much less frequently than fine-needle aspiration.

Incisional biopsies, in which a small slice of tissue is excised from a large lump under local anesthesia, are usually done when the surgeon wants to get a tissue sample for the pathologist, and when removing the entire lump would constitute a major operation. These days fine-needle aspiration is beginning to replace incisional biopsy.

Excisional biopsies involve removing the entire lump and may require general anesthesia. They should not be confused with "lumpectomies" which are operations to remove tumors that have been identified as malignant.
For non-palpable lumps

Wire localization biopsy employing local anesthesia is used for lesions that are picked up on mammography but cannot be felt. A radiologist directs a hollow needle toward the mass detected by the mammogram and passes a thin, hooked wire through it. The needle is removed and a second mammogram taken. If the mammogram reveals that the wire is placed properly it will be used by the surgeon to guide him or her to the lesion. After the tissue is removed, it is x-rayed again to determine whether it matches the suspicious region on the mammogram. If it does, it is sent on to the pathologist.

Stereotactic biopsy is a technique that combines mammography and biopsy and is performed using a local anesthetic. The woman lies face-down on a table that contains an opening for the breast. While a device compresses the breast, a mammogram is taken. The location of the lesion is then plotted by computer. An electronically controlled, computer-guided needle takes a sample from the core of the lesion. Because this technique is still quite new, its false-negative rate (the percentage of cancers missed) hasn't been established.


COMMON BIOPSY TECHNIQUE NOT EFFECTIVE, STUDY FINDS

Common biopsy technique not effective, study finds

A technique commonly used to detect breast cancer often doesn't work. That was the conclusion of a medical research project conducted by the Radiologic Diagnostic Oncology Group. According to the study, fine needle aspiration biopsies frequently do not collect enough breast tissue to make any diagnosis.

Fine needle aspiration biopsies use a very small needle to remove tissue from the area of the breast that appears abnormal on the mammogram. The needle can be inserted into the tissue guided by mammography (stereotactically) or by ultrasound.

An analysis of 351 women who had fine needle aspiration biopsies revealed that, overall, more than a third of the biopsies provided an insufficient tissue sample, stated Dr. Etta Pisano, associate professor of radiology at the University of North Carolina-Chapel Hill and chair of the study. The insufficient sample rate was even higher for some breast abnormalities.

Dr. Pisano presented the study at the American College of Radiology's (ACR's) "27th National Conference on Breast Cancer" in Dallas on April 30, 1996.

SOURCE: "Study Criticizes Fine Needle Biopsy Test for Breast Cancer." News release by the American College of Radiology, April 30, 1996.

The Chiropractic Journal.


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