title: Biopsy confirmation of metastatic sites in breast cancer patients: clinical impact and future perspectives.
abstract: Determination of hormone receptor (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2 status in the primary tumor is clinically relevant to define breast cancer subtypes, clinical outcome,and the choice of therapy. Retrospective and prospective studies suggest that there is substantial discordance in receptor status between primary and recurrent breast cancer. Despite this evidence and current recommendations,the acquisition of tissue from metastatic deposits is not routine practice. As a consequence, therapeutic decisions for treatment in the metastatic setting are based on the features of the primary tumor. Reasons for this attitude include the invasiveness of the procedure and the unreliable outcome of biopsy, in particular for biopsies of lesions at complex visceral sites. Improvements in interventional radiology techniques mean that most metastatic sites are now accessible by minimally invasive methods, including surgery. In our opinion, since biopsies are diagnostic and changes in biological features between the primary and secondary tumors can occur, the routine biopsy of metastatic disease needs to be performed. In this review, we discuss the rationale for biopsy of suspected breast cancer metastases, review issues and caveats surrounding discordance of biomarker status between primary and metastatic tumors, and provide insights for deciding when to perform biopsy of suspected metastases and which one (s) to biopsy. We also speculate on the future translational implications for biopsy of suspected metastatic lesions in the context of clinical trials and the establishment of bio-banks of biopsy material taken from metastatic sites. We believe that such bio-banks will be important for exploring mechanisms of metastasis. In the future,advances in targeted therapy will depend on the availability of metastatic tissue.
authors.forename: Carmen
authors.initials: C
authors.lastname: Criscitiello
authors.forename: Fabrice
authors.initials: F
authors.lastname: André
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Thompson
authors.forename: Michele
authors.initials: M
authors.lastname: De Laurentiis
authors.forename: Angela
authors.initials: A
authors.lastname: Esposito
authors.forename: Lucia
authors.initials: L
authors.lastname: Gelao
authors.forename: Luca
authors.initials: L
authors.lastname: Fumagalli
authors.forename: Marzia
authors.initials: M
authors.lastname: Locatelli
authors.forename: Ida
authors.initials: I
authors.lastname: Minchella
authors.forename: Franco
authors.initials: F
authors.lastname: Orsi
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Curigliano
mesh_terms: D014408:Biomarkers, Tumor / Q000037:antagonists & inhibitors / Q000378:metabolism; D001706:Biopsy / Q000379:methods* / Q000639:trends; D001940:Breast / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy / Q000379:methods / Q000639:trends; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor