Abstract P5-03-04: The role of lung biopsy in the management of lung nodules in breast cancer patients
Authors: Matsuura Kazuo , Kadoya Takayuki , Masumoto Norio , Shigematsu Hideo , Emi Akiko , Kajitani Keiko , Okada Morihito , Kataoka Tsuyoshi , Haruta Rumi , Arihiro Koji , Noma Midori , Itamoto Toshiyuki 
Published: May 2015

Background: A biopsy of lung nodules in patients, who had received previous surgery for breast cancer, can be performed with three aims: to confirm that the lesion is lung metastasis, to confirm the diagnosis of other diseases including primary lung cancer, and to reassess tumor’s characteristics. Discordance in estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancer and metastatic lesions has been reported. The aim of this study was to assess the role of lung biopsy in the diagnosis and to determine the changes in hormonal receptor and HER2 status of the metastatic lesions.

Methods: A total of 38 consecutive patients who underwent surgery in 31 or transbronchial lung biopsy (TBLB) in 7 for lung nodules between 1997 and 2014 after curative operation for breast cancer were reviewed.

Results: Eighteen patients (47%) had a solitary lung nodule. The pathologic diagnoses of lung nodules were lung metastases of breast cancer in 20 patients, primary lung tumor in 14 (Adenocarcinoma in 10; Large cell carcinoma in 2; Small cell carcinoma and Carcinoid tumor in 1 each), and other diagnoses in 4 (Inflammation and organizing pneumonia in 2 each). Median follow up duration were 118.8 months in metastatic breast cancer patients and 105.3 months in other histology patients (p=0.392). The average disease-free interval from the surgery for primary breast cancer were 68.6 months in metastatic breast cancer patients and 66.3 months in other histology patients (p=0.897). The 10-year survival rate after the surgery for primary breast cancer was significantly longer in other histology patients (92.3%), including primary lung cancer patients than in metastatic breast cancer patients (55.1%) (p=0.0308). In 20 cases of metastatic breast cancer, rates of discordance were 5%, 10% and 10% for ER gain, PgR gain and HER2 loss, respectively. Sixteen of patients maintained the same tumor phenotype, whereas 4 changed during progression. Especially, 2 cases of ER, PgR gain could receive endocrine therapy instead of chemotherapy.

Conclusion: As lung nodules that appear in breast cancer patients are not always lung metastases, the pathologic diagnosis should be confirmed, and surgery is an option for the pathologic confirmation. Furthermore, discordance in biomarker status between primary breast cancer and the lung metastasis occurred in 20% of cases. It is necessary for clinicians to check biomarker status in recurrent breast cancer patients as it may assist a shift in the treatment plan.

Citation Format: Kazuo Matsuura, Takayuki Kadoya, Norio Masumoto, Hideo Shigematsu, Akiko Emi, Keiko Kajitani, Morihito Okada, Tsuyoshi Kataoka, Rumi Haruta, Koji Arihiro, Midori Noma, Toshiyuki Itamoto. The role of lung biopsy in the management of lung nodules in breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-03-04.