![]() ![]() In cases of nonpalpable lesions, a stereotactic or ultrasound-guided wire localisation of the tumour was performed preoperatively. The number of FNA or core specimens obtained was at the discretion of the examiner performing the procedure. Treatment methodsīiopsy procedures of palpable masses were carried out by fine-needle aspiration or automated gun, nonpalpable masses, either by sonographically or by stereotactically guided biopsy. In all, 2328 cases remained after excluding women having received preoperative systemic treatment, patients with multifocal disease and in situ carcinomas as the role of SLN biopsy method in this group of patients still needs to be defined. Each participating centre had to undergo a learning period, as has been established by means of quality control ( Pichler-Gebhard et al, 2002). Feasibility and validation of the SLN biopsy method of the participating centres have been demonstrated by the Austrian Sentinel Node Biopsy Study Group previously. Patient data from 12 participating departments of the Austrian Sentinel Node Biopsy Study Group were collected prospectively from 1999 onwards, but data from some centres were obtained retrospectively from 1996 onwards. The purpose of this study was to evaluate the impact of preoperative biopsy on the rate of metastasis to the SLN of patients with primary breast cancer.Ī total of 2502 consecutive women with primary breast cancer, in whom a SLN procedure was performed, were registered by the multi-centre database project (MCDBP) ( Konstantiniuk et al, 2001). The previous analysis carried out by the Austrian Sentinel Node Biopsy Study Group revealed a nonsignificant trend of an increased risk of SLN metastasis after preoperative breast biopsy ( Pichler-Gebhard et al, 2002). With the thorough pathologic examination of the SLN, it is possible to detect even early tumour cell spread in a lymph node, which might not have been seen otherwise. The sentinel node (SLN) is as per definition ‘the first lymph node that receives afferent lymphatic drainage from a primary tumour’. The concept of sentinel lymphadenectomy has been demonstrated to be an accurate staging alternative for breast cancer ( Krag et al, 1993, 1998 Giuliano et al, 1994, 1997 Veronesi et al, 1997 Veronesi et al, 2003). To our knowledge, no study has investigated the rate of breast cancer cell seeding to the axillary nodes for fine-eedle aspiration and large gauge needle biopsy procedures. In theory, tumour seeding into lymphatic or vascular vessels would carry the same risk of axillary lymph node metastases as true lymphatic invasion. Tumour cell displacement rates to the needle tract of up to 30% have been reported ( Youngson et al, 1995 Diaz et al, 1999). However, there has been serious concern about malignant tumour cell displacement promoting iatrogenic tumour spread. Fine-needle aspiration and core biopsy are widely used for evaluation of palpable and nonpalpable suspicious breast lesions. ![]() Modern surgical treatment for breast tumours requires a preoperative diagnosis of malignancy ( Perry, 2001). The conclusion, based on the present data, is that preoperative breast biopsy does not cause artificial tumour cell spread to the SLN, with possible negative impact on the prognosis of breast cancer. In addition, subgroup analyses of the risk for occult micro metastases to the SLN (detected by IHC only) on H&E-negative cases also showed no increased risk associated with preoperative biopsy, OR 1.07 (95% CI, 0.69–1.65). Patients with preoperative breast biopsy showed a 1.37 times (95% CI, 1.13–1.66) increased risk of SLN metastases on univariate analysis, but this result was not persistent when analysis was adjusted for other relevant factors for axillary node metastases, OR 1.09 (95% CI, 0.85–1.40). In all, 1890 patients were available for final analyses 1048 (55.4%) patients had a preoperative diagnosis performed by fine-needle aspiration or core biopsy 641 (33.9%) patients had a positive SLN when conventional H&E and IHC staining was performed. The association of preoperative biopsy with the risk of SLN metastases was examined by regression analyses and tested for possible confounding well-known factors for axillary node metastases. We report the results of 2502 patients with primary breast cancer, who were operated, and a sentinel node biopsy was performed. ![]() The purpose of this study was to investigate the impact of preoperative biopsy on the rate of metastases to the sentinel lymph node (SLN) of patients with primary breast cancer. Preoperative breast biopsy might cause disaggregation of tumour cells and tumour cell spread. ![]()
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