Abstract:
Objective
To investigate the impact of core needle biopsy (CNB) and traditional open surgical biopsy (OSB) on disease-free survival and surgical quality of breast cancer patients.
Methods
We retrospectively analyzed the clinical data of 306 patients with breast cancer diagnosed by CNB or OSB in Breast Disease Center,Guangdong Women and Children’s Hospital from January 2007 to December 2009,including 155 cases in OSB group and 151 cases in CNB group. Kaplan-meier method was used to analyze disease-free survival in the two groups and Cox regression model was used to discuss the factors influencing the prognosis of the patients. Meanwhile the impact of different biopsy methods on the quality of breast cancer surgery was evaluated by the following parameters: breast-conserving rate,rate of positive margin in first breast-conserving surgery,rate of sentinel lymph node biopsy and times of surgeries.Count data were analyzed by Chi-square test,measurement data by t test.
Results
All the patients were followed up for 29 to 83 months (median 59 months).Overall 32 cases(20.6%,32/155) in OSB group and 29 cases(19.2%,29/151) in CNB group had recurrence or metastasis.The local recurrence rate and distant metastasis rate was 4.5% (7/155) and 16.1%(25/155) in OSB group,2.6% (4/151) and 16.5% (25/151) in CNB group,which indicated no significant difference between the two groups (χ2 =0. 769,0. 010,P=0. 380,0. 919). Kaplan-meier survival analysis showed that there was no significant difference in disease-free survival between the two groups (χ2=0.030,P=0.864).Cox regression analysis showed that lymph node metastasis,ER and HER-2 expression were the major influencing factors in the prognosis of breast cancer patients (OR=2.458, 95%CI: 1.883-3.209,P=0.000;OR=0.453,95%CI: 0. 238-0. 863,P=0. 016;OR=2. 086,95%CI: 1. 110-3. 920,P=0.022),and the different methods of biopsy did not affect the disease-free survival.The breast-conserving rate was significantly higher in CNB group than that in OSB group [25.2%(38/151) vs 9.7%(15/155),χ2=12.812,P =0.000],and the patients in CNB group had fewer operations compared with OSB group (1.00±0.00 vs 1.35±0.48,t=9.090,P=0.000),but there was no significant difference in the rate of sentinel lymph node biopsy between the two groups [31.8%(48/151) vs 32.9%(51/155), χ2=0.043,P=0.835].The rate of positive margin in first breast-conserving surgery showed no significant difference between CNB group and OSB group [10.5% (4/38)vs 5/15, χ2=2.515,P =0.113].
Conclusion
Preoperative CNB can provide guidance for the diagnosis,molecular typing and the selection of surgical and subsequent adjuvant treatment plans so as to improve the quality of breast cancer surgery,without adverse effects on disease-free survival of breast cancer patients,which can be regarded as the first choice for the patients with palpable breast mass.
Key words:
Breast neoplasms,
Biopsy,
Prognosis
Yongpan Mo, Xiaorong Han, Kunhe Wu, Hongyi Gao, Jianmin Yang, Qi Wang. Impact of biopsy by core needle biopsy or open surgical biopsy on surgical quality and prognosis of breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2015, 09(01): 39-43.