Breast CA Mets Biopsy Viable; May Impact Management

Receptor discordance does not affect time to treatment failure, overall survival at one year

THURSDAY, Dec. 1 (HealthDay News) -- Biopsy of breast cancer metastases for estrogen (ER), progesterone (PgR), and human epidermal growth factor receptor 2 (HER2) status is feasible and alters management in 14 percent of patients, but receptor discordance is not associated with worse outcome, according to a study published online Nov. 28 in the Journal of Clinical Oncology.

Eitan Amir, M.D., from the University of Toronto, and colleagues examined receptor status in primary breast tumors and metastases in the same patient, and evaluated the impact of discordance on patient management and survival. ER, PgR, and HER2 were analyzed in biopsies of suspected metastases. Similar methodologies were used to analyze primary tumors and metastases. Of the 121 women who underwent biopsy, 80 percent could be analyzed for receptor status and the patients were followed up for progression or death. A treatment plan was indicated before and after biopsy by the treating oncologist.

The investigators found that there was 16, 40, and 10 percent discordance in ER, PgR, and HER2, respectively, between the primary tumor and the metastasis. Following biopsy, there was a reported change of management in 14 percent of women. Bone biopsy and fine-needle aspiration resulted in decreased ability to analyze receptors. After a 12-month median follow-up, no trends were seen indicating a correlation between receptor discordance and either time to treatment failure or overall survival.

"Clinicians alter immediate management in one of seven patients on the basis of results of the biopsy, and discordance is not then associated with detrimental effects on outcome," the authors write.

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