Main Article Content
Breast, Displaced epithelium, Iatrogenic, Histopathology
Background: Although iatrogenic displacement of epithelial cells after breast instrumentation is a well-documented phenomenon, it is usually underdiagnosed. Misinterpretation of this issue results in overtreatment of patients in some instances. Additionally, the hazard of tumor seeding and dissemination after needling is a concern to both clinicians and patients. Both issues are addressed in this narrative review.
Methods: We searched PubMed for abstracts of English-language publications using keywords “needle track/tract” and “displaced epithelium/epithelial displacement/iatrogenic displacement,” which resulted in 439 records restricted to human subjects. We read all the abstracts and selected 27 manuscripts with the most relevance.
Results: There are some histopathologic features that can be useful in differentiating between epithelial displacement and real invasion/metastasis. The risk of seeding or metastasis after needling is shown to be trivial. Factors militating against the growth of dislodged cells are also discussed.
Conclusion: Epithelial displacement is an important issue in breast pathology that should be considered in every patient with a history of breast instrumentation.
2. Ito Y, Asahi S, Matsuzuka F, Nakamura Y, Amino N, et al. Needle tract implantation of follicular neoplasm after fine-needle aspiration biopsy: report of a case. Thyroid. 2006;16(10):1059-62.
3. Volpe A, Kachura JR, Geddie WR, Evans AJ, Gharajeh A, et al. Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol. 2007;178(2):379-86.
4. Stokes ME, Thompson D, Montoya EL, Weinstein MC, Winer EP, et al. Ten-year survival and cost following breast cancer recurrence: estimates from SEER-medicare data. Value Health. 2008;11(2):213-20.
5. Horn T, Seidl S, Gschwend JE, Kubler H. Implantation metastasis of prostate cancer in a suprapubic cystostomy tube needle tract. Prostate Cancer Prostatic Dis. 2010;13(3):292-4.
6. Scotti V, Di Cataldo V, Falchini M, Meattini I, Livi L, et al. Isolated chest wall implantation of non-small cell lung cancer after fine-needle aspiration: a case report and review of the literature. Tumori. 2012;98(5):126e-9e.
7. Carlin SP, Garcia-Botella A, Diez-Valladares L, Perez-Aguirre E, Ortega L, et al. Dissemination of hepatocellular carcinoma in subcutaeous tissue after fine needle aspiration cytology (FNAC). Hepatogastroenterology. 2013;60(128):1839-40.
8. International Breast Cancer Consensus C. Image-detected breast cancer: state of the art diagnosis and treatment. International Breast Cancer Consensus Conference. J Am Coll Surg. 2001;193(3):297-302.
9. Perry NM, Party EW. Quality assurance in the diagnosis of breast disease. EUSOMA Working Party. Eur J Cancer. 2001;37(2):159-72.
10. Clarke-Pearson EM, Jacobson AF, Boolbol SK, Leitman IM, Friedmann P, et al. Quality assurance initiative at one institution for minimally invasive breast biopsy as the initial diagnostic technique. J Am Coll Surg. 2009;208(1):75-8.
11. Gutwein LG, Ang DN, Liu H, Marshall JK, Hochwald SN, et al. Utilization of minimally invasive breast biopsy for the evaluation of suspicious breast lesions. Am J Surg. 2011;202(2):127-32.
12. Torous VF, Schnitt SJ, Collins LC. Benign breast lesions that mimic malignancy. Pathology. 2017;49(2):181-96.
13. Hoorntje LE, Schipper ME, Kaya A, Verkooijen HM, Klinkenbijl JG, et al. Tumour cell displacement after 14G breast biopsy. Eur J Surg Oncol. 2004;30(5):520-5.
14. Liebens F, Carly B, Cusumano P, Van Beveren M, Beier B, et al. Breast cancer seeding associated with core needle biopsies: a systematic review. Maturitas. 2009;62(2):113-23.
15. Chao C, Torosian MH, Boraas MC, Sigurdson ER, Hoffman JP, et al. Local recurrence of breast cancer in the stereotactic core needle biopsy site: case reports and review of the literature. Breast J. 2001;7(2):124-7.
16. Cho E, Kim MH, Cha SH, Cho SH, Oh SJ, et al. Breast cancer cutaneous metastasis at core needle biopsy site. Ann Dermatol. 2010;22(2):238-40.
17. Brenner RJ, Gordon LM. Malignant seeding following percutaneous breast biopsy: documentation with comprehensive imaging and clinical implications. Breast J. 2011;17(6):651-6.
18. Santiago L, Adrada BE, Huang ML, Wei W, Candelaria RP. Breast cancer neoplastic seeding in the setting of image-guided needle biopsies of the breast. Breast Cancer Res Treat. 2017;166(1):29-39.
19. Ansari TZ, Zaidi AA, Parekh A, Iqbal O, Masood N, et al. Factors influencing the opinion of individuals in determining tumour spread after biopsy. BMC Res Notes. 2011;4:548.
20. Youngson BJ, Cranor M, Rosen PP. Epithelial displacement in surgical breast specimens following needling procedures. Am J Surg Pathol. 1994;18(9):896-903.
21. Youngson BJ, Liberman L, Rosen PP. Displacement of carcinomatous epithelium in surgical breast specimens following stereotaxic core biopsy. Am J Clin Pathol. 1995;103(5):598-602.
22. Diaz LK, Wiley EL, Venta LA. Are malignant cells displaced by large-gauge needle core biopsy of the breast? AJR Am J Roentgenol. 1999;173(5):1303-13.
23. Liberman L, Vuolo M, Dershaw DD, Morris EA, Abramson AF, et al. Epithelial displacement after stereotactic 11-gauge directional vacuum-assisted breast biopsy. AJR Am J Roentgenol. 1999;172(3):677-81.
24. Thurfjell MG, Jansson T, Nordgren H, Bergh J, Lindgren A, et al. Local breast cancer recurrence caused by mammographically guided punctures. Acta Radiol. 2000;41(5):435-40.
25. Douglas-Jones AG, Verghese A. Diagnostic difficulty arising from displaced epithelium after core biopsy in intracystic papillary lesions of the breast. J Clin Pathol. 2002;55(10):780-3.
26. Knight R, Horiuchi K, Parker SH, Ratzer ER, Fenoglio ME. Risk of needle-track seeding after diagnostic image-guided core needle biopsy in breast cancer. JSLS. 2002;6(3):207-9.
27. Nagi C, Bleiweiss I, Jaffer S. Epithelial displacement in breast lesions: a papillary phenomenon. Arch Pathol Lab Med. 2005;129(11):1465-9.
28. Bleiweiss IJ, Nagi CS, Jaffer S. Axillary sentinel lymph nodes can be falsely positive due to iatrogenic displacement and transport of benign epithelial cells in patients with breast carcinoma. J Clin Oncol. 2006;24(13):2013-8.
29. Fitzal F, Sporn EP, Draxler W, Mittlbock M, Taucher S, et al. Preoperative core needle biopsy does not increase local recurrence rate in breast cancer patients. Breast Cancer Res Treat. 2006;97(1):9-15.
30. Phelan S, O'Doherty A, Hill A, Quinn CM. Epithelial displacement during breast needle core biopsy causes diagnostic difficulties in subsequent surgical excision specimens. J Clin Pathol. 2007;60(4):373-6.
31. Michalopoulos NV, Zagouri F, Sergentanis TN, Pararas N, Koulocheri D, et al. Needle tract seeding after vacuum-assisted breast biopsy. Acta Radiol. 2008;49(3):267-70.
32. Uematsu T, Kasami M. Risk of needle tract seeding of breast cancer: cytological results derived from core wash material. Breast Cancer Res Treat. 2008;110(1):51-5.
33. van Deurzen CH, Bult P, de Boer M, Koelemij R, van Hillegersberg R, et al. Morphometry of isolated tumor cells in breast cancer sentinel lymph nodes: metastases or displacement? Am J Surg Pathol. 2009;33(1):106-10.
34. Koo JS, Jung WH, Kim H. Epithelial displacement into the lymphovascular space can be seen in breast core needle biopsy specimens. Am J Clin Pathol. 2010;133(5):781-7.
35. McLaughlin CS, Petrey C, Grant S, Ransdell JS, Reynolds C. Displaced epithelium after liposuction for gynecomastia. Int J Surg Pathol. 2011;19(4):510-3.
36. Tvedskov TF, Jensen MB, Kroman N, Balslev E. Iatrogenic displacement of tumor cells to the sentinel node after surgical excision in primary breast cancer. Breast Cancer Res Treat. 2012;131(1):223-9.
37. Nayak A, Bleiweiss IJ. Iatrogenically false positive sentinel lymph nodes in breast cancer: Methods of recognition and evaluation. Semin Diagn Pathol. 2018;35(4):228-35.
38. Loughran CF, Keeling CR. Seeding of tumour cells following breast biopsy: a literature review. Br J Radiol. 2011;84(1006):869-74.
39. Pisano ED, Fajardo LL, Tsimikas J, Sneige N, Frable WJ, et al. Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial: The Radiologic Diagnostic Oncology Group 5 Study. The RDOG5 investigators. Cancer. 1998;82(4):679-88.
40. Altomare V, Guerriero G, Giacomelli L, Battista C, Carino R, et al. Management of nonpalpable breast lesions in a modern functional breast unit. Breast Cancer Res Treat. 2005;93(1):85-9.
41. Dhillon MS, Bradley SA, England DW. Mammotome biopsy: impact on preoperative diagnosis rate. Clin Radiol. 2006;61(3):276-81.
42. Liberman L, Hann LE, Dershaw DD, Morris EA, Abramson AF, et al. Mammographic findings after stereotactic 14-gauge vacuum biopsy. Radiology. 1997;203(2):343-7.
43. Stolier A, Skinner J, Levine EA. A prospective study of seeding of the skin after core biopsy of the breast. Am J Surg. 2000;180(2):104-7.
44. Boutin C, Rey F, Viallat JR. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest. 1995;108(3):754-8.
45. Peters-Engl C, Konstantiniuk P, Tausch C, Haid A, Hoffmann B, et al. The impact of preoperative breast biopsy on the risk of sentinel lymph node metastases: analysis of 2502 cases from the Austrian Sentinel Node Biopsy Study Group. Br J Cancer. 2004;91(10):1782-6.
46. Yeh IT, Mies C. Application of immunohistochemistry to breast lesions. Arch Pathol Lab Med. 2008;132(3):349-58.
47. Diaz NM, Cox CE, Ebert M, Clark JD, Vrcel V, et al. Benign mechanical transport of breast epithelial cells to sentinel lymph nodes. Am J Surg Pathol. 2004;28(12):1641-5.
48. Tada K, Ogiya A, Kimura K, Morizono H, Iijima K, et al. Ductal carcinoma in situ and sentinel lymph node metastasis in breast cancer. World J Surg Oncol. 2010;8:6.
49. Shyamala K, Girish HC, Murgod S. Risk of tumor cell seeding through biopsy and aspiration cytology. J Int Soc Prev Community Dent. 2014;4(1):5-11.
50. Allawi Z, Cuzick J, Baum M, investigators AL. Does trauma or an intercurrent surgical intervention lead to a short-term increase in breast cancer recurrence rates? Ann Oncol. 2012;23(4):866-9.
51. Hanahan D, Coussens LM. Accessories to the crime: functions of cells recruited to the tumor microenvironment. Cancer Cell. 2012;21(3):309-22.
52. Decker AM, Cackowski FC, Jung Y, Taichman RS. Biochemical Changes in the Niche Following Tumor Cell Invasion. J Cell Biochem. 2017;118(8):1956-64.
53. Jones DL, Wagers AJ. No place like home: anatomy and function of the stem cell niche. Nat Rev Mol Cell Biol. 2008;9(1):11-21.
54. Huch M, Rawlins EL. Cancer: Tumours build their niche. Nature. 2017;545(7654):292-3.
55. Melzer C, von der Ohe J, Lehnert H, Ungefroren H, Hass R. Cancer stem cell niche models and contribution by mesenchymal stroma/stem cells. Mol Cancer. 2017;16(1):28.
56. Massague J, Obenauf AC. Metastatic colonization by circulating tumour cells. Nature. 2016;529(7586):298-306.
57. Kopans DB, Gallagher WJ, Swann CA, McCarthy KA, White G, et al. Does preoperative needle localization lead to an increase in local breast cancer recurrence? Radiology. 1988;167(3):667-8.
58. Giuliano AE, Hawes D, Ballman KV, Whitworth PW, Blumencranz PW, et al. Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer. JAMA. 2011;306(4):385-93.
59. Weaver DL, Ashikaga T, Krag DN, Skelly JM, Anderson SJ, et al. Effect of occult metastases on survival in node-negative breast cancer. N Engl J Med. 2011;364(5):412-21.
Article Statistics :Views : 1811 | Downloads : 1291