title: Should liver metastases of breast cancer be biopsied to improve treatment choice?
abstract: BACKGROUND
  Currently, the acquisition of tissue from metastatic deposits is not recommended as a routine practice. Our aim was to evaluate the discordance rate of estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2) receptor status between primary tumor and liver metastases and its potential impact on treatment choice.
  
  
  METHODS
  We retrospectively analyzed a database including 1250 ultrasound-guided liver biopsies carried out at the European Institute of Oncology from August 1999 to March 2009. ER, PgR, and HER2 status were determined by immunohistochemistry and/or FISH. Differences between proportions were evaluated using Fisher's exact test.
  
  
  RESULTS
  We identified 255 consecutive patients with matched primary and liver tissue samples. Changes in ER status were observed in 37 of 255 patients (14.5%). Changes in PgR status were observed in 124 of 255 patients (48.6%). Changes in HER2 status were observed in 24 of 172 assessable patients (13.9%). We observed a discordance in receptor status (ER, PgR, and HER2) between primary tumor and liver metastases, which led to change in therapy for 31 of 255 of patients (12.1%).
  
  
  CONCLUSIONS
  Biopsy of metastases for reassessment of biological features should be considered in all patients, when safe and easy to carry out, since it is likely to impact treatment choice.
authors.affiliation: Department of Medicine, Division of Medical Oncology, Istituto Europeo di Oncologia, Milan, Italy. giuseppe.curigliano@ieo.it
authors.forename: G
authors.initials: G
authors.lastname: Curigliano
authors.forename: V
authors.initials: V
authors.lastname: Bagnardi
authors.forename: G
authors.initials: G
authors.lastname: Viale
authors.forename: L
authors.initials: L
authors.lastname: Fumagalli
authors.forename: N
authors.initials: N
authors.lastname: Rotmensz
authors.forename: G
authors.initials: G
authors.lastname: Aurilio
authors.forename: M
authors.initials: M
authors.lastname: Locatelli
authors.forename: G
authors.initials: G
authors.lastname: Pruneri
authors.forename: S
authors.initials: S
authors.lastname: Giudici
authors.forename: M
authors.initials: M
authors.lastname: Bellomi
authors.forename: P
authors.initials: P
authors.lastname: Della Vigna
authors.forename: L
authors.initials: L
authors.lastname: Monfardini
authors.forename: F
authors.initials: F
authors.lastname: Orsi
authors.forename: F
authors.initials: F
authors.lastname: Nolè
authors.forename: E
authors.initials: E
authors.lastname: Munzone
authors.forename: A
authors.initials: A
authors.lastname: Goldhirsch
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis; D011960:Receptors, Estrogen / Q000096:biosynthesis; D011980:Receptors, Progesterone / Q000096:biosynthesis; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone