Does the taking of biopsies affect the metastatic potential of tumours? A systematic review of reports on veterinary and human cases and animal models

Our plain-English summary of Does the taking of biopsies affect the metastatic potential of tumours? A systematic review of reports on veterinary and human cases and animal models, by R. Klopfleisch, C. Sperling, O. Kershaw, et al (The Veterinary Journal, 2011).

The study

• Authors: R. Klopfleisch, C. Sperling, O. Kershaw, A.D. Gruber
• Journal: The Veterinary Journal
• Published: 2011;190(2):e31-e42
• Type of article: Systematic review
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Clinicians and pathologists are sporadically asked by owners whether the taking of tumour biopsies may affect the behaviour of the tumour, including its potential to metastasise. Unfortunately, systematic studies on this subject are unavailable in veterinary medicine, and the aim of this study was to estimate the risk of adverse effects of biopsy taking on tumour progression in animals. A systematic review of veterinary and human case reports and clinical studies as well as experimental animal models of biopsy-induced tumour metastasis was undertaken. There were only two veterinary case reports of needle tract metastases (NTM) following the taking of needle biopsies from urogenital and pulmonary tumours. Seventeen experimental studies found a high incidence of NTM but only a rat osteosarcoma and a hamster squamous carcinoma model showed an increased incidence of distant or regional metastases after incision or excision biopsy. In human medicine, the occurrence of NTM has been reported after the taking of biopsies from mesotheliomas (15%), melanomas (11%) and gall bladder tumours (11%), liver metastases of colon carcinomas (4%) and mammary carcinomas (4%) but an incidence of only <1% for all other tumours. Circulating tumour cells increased immediately after the taking of biopsies from human squamous cell, prostate, breast and hepatocellular carcinomas. Although no increased risk of biopsy-induced distant metastasis has been reported for any type of tumour, this is inconclusive due to a lack of non-biopsied control groups in human studies. Reports of biopsy-induced metastasis in animal tumours indicate that the taking of transcutaneous biopsies from urogenital tumours may be associated with a risk of NTM. However, there is no evidence of a general increase in risk of distant metastases in any tumour type in people or animals. The overall risk therefore appears to be negligible when compared to the valuable information obtained from biopsies in veterinary practice.

Copyright © 2011 Elsevier Ltd. All rights reserved.

In plain English

This article was a systematic review. The authors searched literature from 1966 to March 2010 on whether taking tumour biopsies changes how tumours spread. They found two veterinary case reports, 17 animal experiments and 269 human reports. The veterinary reports described six animals with tumour growth along the needle path (needle tract metastases) after fine needle aspiration. Among human tumours, the text reported the highest needle tract metastasis rates for mesotheliomas (15%; 36 of 238), cutaneous melanomas and gall bladder carcinomas (11% each), though its table gave 16% for liver metastases of colon carcinomas. In human reports, which lacked non-biopsied comparison groups, the authors found no evidence-based increase in lymph node or distant metastases for any tumour type. In animal models, regional lymph node metastases rose after biopsy in hamster squamous cell carcinoma models, and distant metastases rose slightly in one rat osteosarcoma model. They suggested mesotheliomas' own tendency to seed body cavity linings may explain their higher rate, rather than the biopsy itself. The authors concluded that the risk of biopsy-induced distant metastasis seemed low. It did not study asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review of veterinary and human case reports, clinical studies and experimental animal models
• Who was studied: Published reports from 1966 to March 2010: 2 veterinary case reports (6 animal cases), 17 experimental animal studies (mouse, rat, hamster, rabbit, dog), and 269 human case reports and clinical studies
• Exposure: Tumour biopsy procedures: needle biopsies (fine needle aspirates, core needle, cutting needle), endoscopic biopsies, and shave, surgical and brush biopsies. Asbestos or fiber exposure was not studied.
• Main results:
  • Veterinary cases: in all six animals (one pulmonary carcinoma, four transitional cell carcinomas, one prostate carcinoma), fine needle aspiration through the skin was followed by needle tract metastases. No distant metastases were observed.
  • Human mesotheliomas: needle tract metastases were reported in 36 of 238 cases (15%)
  • Human reports: the text gives a needle tract metastasis incidence of 11% for cutaneous melanomas and 11% for gall bladder carcinomas
  • Human liver metastases of colon carcinomas: Table 6 reports needle tract metastases in 29 of 184 cases (16%). The results text gives 7% and the abstract 4% for this group.
  • Human reports: an evidence-based increased incidence of lymph node or distant metastases was not identified for any tumour type, because studies lacked non-biopsied control groups
  • Hamster and rabbit squamous cell carcinoma models: excision and incision biopsy were followed by a 41% incidence of needle tract metastases and a 2.6-fold increased incidence of regional lymph node metastases compared with controls. Distant metastases were not observed.
  • Rat osteosarcoma model: the discussion describes a slightly increased incidence of distant metastases after biopsy
  • Human unspecified abdominal tumours: needle tract metastasis incidence of 0.007% (20 of 278,514 biopsies). Human unspecified thoracic tumours: 0.02% (8 of 68,436 biopsies).
  • Prostate tumours: circulating tumour cells increased after biopsy of both malignant and benign prostate tumours
  • The authors suggested that tumour-specific properties of mesotheliomas, whose cells are present in high numbers in body cavity fluids, may contribute to their higher needle tract metastasis rate, rather than the biopsy itself
• The authors' conclusion: The authors concluded that the risk of biopsy-induced distant metastasis seems low and may be considered negligible compared with the information biopsies provide. They also urged caution with transcutaneous biopsies of urogenital tract tumours in companion animals.
• Limitations the authors state:
  • Conclusions about distant metastases in human medicine are limited because studies lack non-biopsied control groups
  • There are too few veterinary case reports and no conclusive clinical studies, so the authors could not make a final risk estimate for veterinary medicine
  • No animal models of lower urogenital tract tumours were found

Topics

Medical terms in this study, explained in our Lexicon: Systematic Review, Biopsy, Metastasis, Carcinoma, Mesothelioma, Squamous Cell.

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