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Annals of Oncology Advance Access originally published online on March 18, 2009
Annals of Oncology 2009 20(9):1499-1504; doi:10.1093/annonc/mdp028
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
The online version of this article has been published under an open access model. users are entitle to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and the European Society for Medical Oncology are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

breast cancer

Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?

C. Simmons1,2, N. Miller3, W. Geddie3, D. Gianfelice4, M. Oldfield1,2, G. Dranitsaris1 and M. J. Clemons1,2,*

1 Division of Hematology and Medical Oncology, Princess Margaret Hospital
2 Department of Medicine
3 Division of Pathology, University Health Network
4 Department of Interventional Radiology, University Health Network, University of Toronto, Canada

* Correspondence to: Dr M. J. Clemons, Division of Hematology and Medical Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. Tel: +1-416-946-4534; Fax: +1-416-946-2983; E-mail: mark.clemons{at}uhn.on.ca

Background: Decisions about systemic treatment of women with metastatic breast cancer are often based on estrogen receptor (ER), progesterone receptor (PgR), and Her2 status of the primary tumor. This study prospectively investigated concordance in receptor status between primary tumor and distant metastases and assessed the impact of any discordance on patient management.

Materials and methods: Biopsies of suspected metastatic lesions were obtained from patients and analyzed for ER/PgR and Her2. Receptor status was compared for metastases and primary tumors. Questionnaires were completed by the oncologist before and after biopsy to determine whether the biopsy results changed the treatment plan.

Results: Forty women were enrolled; 35 of them underwent biopsy, yielding 29 samples sufficient for analysis; 3/29 biopsies (10%) showed benign disease. Changes in hormone receptor status were observed in 40% (P = 0.003) and in Her2 status in 8% of women. Biopsy results led to a change of management in 20% of patients (P = 0.002).

Conclusions: This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence.

Key words: breast cancer, metastatic, receptor discordance

Received for publication January 9, 2009. Accepted for publication January 15, 2009.


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