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Biopsy Reduces Lesion Size, Which May Cause Errors in Pathologic Staging: Presented at ASBD

By Peggy Peck

BOSTON, MA -- April 29, 2004 -- Core needle biopsy reduces the size of breast tumors, and that reduction could lead to an error in pathologic staging, which may affect decisions about possible use of adjuvant therapy, according to research presented here on April 24^th at the American Society of Breast Disease (ASBD) 28^th Annual Symposium.

W.S. Lee, MD, and colleagues, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, conducted a retrospective analysis to compare the effects on lesion size of core needle biopsy and fine needle aspiration.

These researchers conducted a retrospective analysis of 291 patients with invasive breast carcinoma who were treated between January 2000 and May 2002. The patients who underwent ultrasonography guided core needle biopsy included 199 cases, and 92 cases had fine needle aspiration before surgical manipulation. Tumor size was measured clinically using ultrasonography and compared with the pathologic tumor size in both core needle biopsy and fine needle aspiration groups.

The researchers found that changes in size from preoperative measurements by sonography and pathologic measurements on surgical specimens were larger in the group that underwent core needle biopsy than in the fine needle aspiration group (0.46 cm vs. 0.31 cm; P = 0.01)."

Sheldon Feldman, MD, associate professor, Albert Einstein College of Medicine, and chief, Louis Venet, M.D., Comprehensive Breast Center, Beth Israel Medical Center, New York, said in an interview that the finding suggests, "one should always rely on ultrasound to determine the size of the tumor. I think this study can raise awareness among oncologists about the danger of relying solely on examination of the lesion."

Dr. Feldman, who was not involved in the study but served as ASBD discussant for the poster, added, however, that the size difference is most important "when the lesion is borderline -- when a core needle biopsy can mean the difference between a lesion that is more than 2 cm and one that is 1.8 cm."

The authors concluded that core needle biopsy altered significantly the size of pathologic specimens. "Although the reduction of tumor size may be small with patients who underwent [core needle biopsy], it must be considered when adjuvant treatment is being decided, especially tumors size that are on the borderline stage."

[Presentation title: "Effect of Core Needle Biopsy Versus Fine Needle Aspiration on Pathologic Measurement of Tumor Size in Breast Cancer." Poster #8]

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