Biopsy confirmation of metastatic sites in breast cancer patients: clinical impact and future perspectives

Carmen Criscitiello; Fabrice André; Alastair M. Thompson; Michele De Laurentiis; Angela Esposito; Lucia Gelao; Luca Fumagalli; Marzia Locatelli; Ida Minchella; Franco Orsi; Aron Goldhirsch; Guiseppe Curigliano

doi:10.1186/bcr3630

Biopsy confirmation of metastatic sites in breast cancer patients: clinical impact and future perspectives

Carmen Criscitiello
, Fabrice André
, Alastair M. Thompson
, Michele De Laurentiis
, Angela Esposito
, Lucia Gelao
, Luca Fumagalli
, Marzia Locatelli
, Ida Minchella
, Franco Orsi
, Aron Goldhirsch
, Guiseppe Curigliano (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

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Abstract

Determination of hormone receptor (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2 status in the primary tumor is clinically relevant to define breast cancer subtypes, clinical outcome, and the choice of therapy. Retrospective and prospective studies suggest that there is substantial discordance in receptor status between primary and recurrent breast cancer. Despite this evidence and current recommendations, the acquisition of tissue from metastatic deposits is not routine practice. As a consequence, therapeutic decisions for treatment in the metastatic setting are based on the features of the primary tumor. Reasons for this attitude include the invasiveness of the procedure and the unreliable outcome of biopsy, in particular for biopsies of lesions at complex visceral sites. Improvements in interventional radiology techniques mean that most metastatic sites are now accessible by minimally invasive methods, including surgery. In our opinion, since biopsies are diagnostic and changes in biological features between the primary and secondary tumors can occur, the routine biopsy of metastatic disease needs to be performed. In this review, we discuss the rationale for biopsy of suspected breast cancer metastases, review issues and caveats surrounding discordance of biomarker status between primary and metastatic tumors, and provide insights for deciding when to perform biopsy of suspected metastases and which one (s) to biopsy. We also speculate on the future translational implications for biopsy of suspected metastatic lesions in the context of clinical trials and the establishment of bio-banks of biopsy material taken from metastatic sites. We believe that such bio-banks will be important for exploring mechanisms of metastasis. In the future, advances in targeted therapy will depend on the availability of metastatic tissue.

Original language	English
Article number	205
Number of pages	10
Journal	Breast Cancer Research
Volume	16
Issue number	2
DOIs	https://doi.org/10.1186/bcr3630
Publication status	Published - 21 Mar 2014

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bcr3630
1. The article is universally and freely accessible via the Internet, in an easily readable format and deposited immediately upon publication, without embargo, in an agreed format - current preference is XML with a declared DTD - in at least one widely and internationally recognized open access repository (such as PubMed Central). The author(s) or copyright owner(s) irrevocably grant(s) to any third party, in advance and in perpetuity, the right to use, reproduce or disseminate the research article in its entirety or in part, in any format or medium, provided that no substantive errors are introduced in the process, proper attribution of authorship and correct citation details are given, and that the bibliographic details are not changed. If the article is reproduced or disseminated in part, this must be clearly and unequivocally indicated. Articles in BioMed Central's journals are published under the Creative Commons Attribution license (CC-BY) to ensure implementation of open access as defined.
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Cite this

Criscitiello, C., André, F., Thompson, A. M., De Laurentiis, M., Esposito, A., Gelao, L., Fumagalli, L., Locatelli, M., Minchella, I., Orsi, F., Goldhirsch, A., & Curigliano, G. (2014). Biopsy confirmation of metastatic sites in breast cancer patients: clinical impact and future perspectives. Breast Cancer Research, 16(2), Article 205. https://doi.org/10.1186/bcr3630

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abstract = "Determination of hormone receptor (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2 status in the primary tumor is clinically relevant to define breast cancer subtypes, clinical outcome, and the choice of therapy. Retrospective and prospective studies suggest that there is substantial discordance in receptor status between primary and recurrent breast cancer. Despite this evidence and current recommendations, the acquisition of tissue from metastatic deposits is not routine practice. As a consequence, therapeutic decisions for treatment in the metastatic setting are based on the features of the primary tumor. Reasons for this attitude include the invasiveness of the procedure and the unreliable outcome of biopsy, in particular for biopsies of lesions at complex visceral sites. Improvements in interventional radiology techniques mean that most metastatic sites are now accessible by minimally invasive methods, including surgery. In our opinion, since biopsies are diagnostic and changes in biological features between the primary and secondary tumors can occur, the routine biopsy of metastatic disease needs to be performed. In this review, we discuss the rationale for biopsy of suspected breast cancer metastases, review issues and caveats surrounding discordance of biomarker status between primary and metastatic tumors, and provide insights for deciding when to perform biopsy of suspected metastases and which one (s) to biopsy. We also speculate on the future translational implications for biopsy of suspected metastatic lesions in the context of clinical trials and the establishment of bio-banks of biopsy material taken from metastatic sites. We believe that such bio-banks will be important for exploring mechanisms of metastasis. In the future, advances in targeted therapy will depend on the availability of metastatic tissue.",

author = "Carmen Criscitiello and Fabrice Andr{\'e} and Thompson, \{Alastair M.\} and \{De Laurentiis\}, Michele and Angela Esposito and Lucia Gelao and Luca Fumagalli and Marzia Locatelli and Ida Minchella and Franco Orsi and Aron Goldhirsch and Guiseppe Curigliano",

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AU - Criscitiello, Carmen

AU - André, Fabrice

AU - Thompson, Alastair M.

AU - De Laurentiis, Michele

AU - Esposito, Angela

AU - Gelao, Lucia

AU - Fumagalli, Luca

AU - Locatelli, Marzia

AU - Minchella, Ida

AU - Orsi, Franco

AU - Goldhirsch, Aron

AU - Curigliano, Guiseppe

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AB - Determination of hormone receptor (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2 status in the primary tumor is clinically relevant to define breast cancer subtypes, clinical outcome, and the choice of therapy. Retrospective and prospective studies suggest that there is substantial discordance in receptor status between primary and recurrent breast cancer. Despite this evidence and current recommendations, the acquisition of tissue from metastatic deposits is not routine practice. As a consequence, therapeutic decisions for treatment in the metastatic setting are based on the features of the primary tumor. Reasons for this attitude include the invasiveness of the procedure and the unreliable outcome of biopsy, in particular for biopsies of lesions at complex visceral sites. Improvements in interventional radiology techniques mean that most metastatic sites are now accessible by minimally invasive methods, including surgery. In our opinion, since biopsies are diagnostic and changes in biological features between the primary and secondary tumors can occur, the routine biopsy of metastatic disease needs to be performed. In this review, we discuss the rationale for biopsy of suspected breast cancer metastases, review issues and caveats surrounding discordance of biomarker status between primary and metastatic tumors, and provide insights for deciding when to perform biopsy of suspected metastases and which one (s) to biopsy. We also speculate on the future translational implications for biopsy of suspected metastatic lesions in the context of clinical trials and the establishment of bio-banks of biopsy material taken from metastatic sites. We believe that such bio-banks will be important for exploring mechanisms of metastasis. In the future, advances in targeted therapy will depend on the availability of metastatic tissue.

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Biopsy confirmation of metastatic sites in breast cancer patients: clinical impact and future perspectives

Abstract

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