Biopsy of recurrence in breast cancer

Immunohistochemistry discrepancy between prymary tumor and metastases.

Hormonal receptors discrepancy around 40% Also different profile for HER-2 marker Most of the studies are retrospectives on design

J Clin Oncol 30:587-592 2012

The NCCN Panel recommends that metastatic disease at presentation or first recurrence of disease should be biopsied as a part of the workup for patients with recurrent or stage IV disease. This ensures accurate determination of metastatic/ recurrent disease and tumor histology, and allows for biomarker determination and selection of appropriate treatment.

http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf

Efforts should be made to obtain histopathological confirmation whenever technically feasible, particularly in the situation of an isolated metastatic lesion. Biological markers important for treatment decisions, such as steroid hormone receptors (ER, PR) and HER-2 status should be re-evaluated, at least once, in a metastatic lesion.

What is the eviddence?

HER2 discordance between primary breast cancer and its paired metastasis: tumor biology or test artefact? Insights through meta-analysisNehmat Houssami, Petra Macaskill, Rosemary L. Balleine, Michael Bilous,Mark D. Pegram

Breast Cancer Res Treat 129, 659-674 (2011)

2520 patints, 26 retrospectives studies.

Discordancy ratio: 5.5% (3.6 -8.5%)

Major discrepancy between initial diagnosis and metastases, less for regional nodes.

(4.1% vs 3.3%)

More evidence

DESTINY

Proposed algorithm for biopsy of recurrence in breast cancer

The Oncologist 2010: 15: 1164-1168

Nature Reviews Clin Oncol 2013