title: Breast cancer seeding associated with core needle biopsies: a systematic review.
abstract: BACKGROUND
  Preoperative diagnosis has become the standard in breast cancer (BC) management. Recently, ultrasound guided core needle biopsy (CNB) and stereotactic needle core biopsy have replaced fine needle aspiration cytology. Epithelial cell displacement (DE) occurs frequently after core needle biopsy (CNB) for breast cancer diagnosis.
  
  
  OBJECTIVE
  Systematically review (between 1900 and 2008) the clinical significance of DE after CNB in BC patients, and associated risk factors (delay between biopsy and surgery, needle passes, duration of the procedure, tumor size, histological type, tumor grade, margins, type of surgery, and of adjuvant treatment).
  
  
  METHODS
  We selected 15 studies: 9 assessed the rate of DE after CNB and 6 the impact of CNB on outcome endpoints.
  
  
  RESULTS
  We found 3 prospective and 12 retrospective studies. However these had numerous biases such as insufficient power, confounding factors, selection of cases and controls, surrogate endpoints, heterogeneity of measured displacement. Malignant DE on surgical specimens occurred in 22% of the patients. A short interval between CNB and surgical excision increased the risk of detecting displaced cells. No increase in local recurrence was reported after CNB. Contradictory results were found in terms of sentinel node metastases. Only one study evaluated overall survival data and reported no worse survival in patients with preoperative CNB.
  
  
  CONCLUSIONS
  Although data are limited, no increased morbidity has been associated with iatrogenic seeding after CNB.
authors.affiliation: Breast Unit, ISALA Breast Cancer Prevention Center and High Risk Clinic Dept OB-Gyn, St. Pierre University Hospital, Haute Str. 290, B-1000 Brussels, Belgium.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Liebens
authors.forename: Birgit
authors.initials: B
authors.lastname: Carly
authors.forename: Pino
authors.initials: P
authors.lastname: Cusumano
authors.forename: Martine
authors.initials: M
authors.lastname: Van Beveren
authors.forename: Barbara
authors.initials: B
authors.lastname: Beier
authors.forename: Maxime
authors.initials: M
authors.lastname: Fastrez
authors.forename: Serge
authors.initials: S
authors.lastname: Rozenberg
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D004847:Epithelial Cells; D006801:Humans; D009362:Neoplasm Metastasis; D012008:Recurrence; D012307:Risk Factors; D019564:Unnecessary Procedures