Amir E, Ooi W S, Simmons C, Kahn H, Christakis M, Popovic S, Kalina M, Chesney A, Singh G, Clemons M
Princess Margaret Hospital, Toronto M5G 2M9, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2008 Dec;20(10):763-8. doi: 10.1016/j.clon.2008.08.005. Epub 2008 Sep 27.
The treatment of bone metastases in breast cancer is traditionally based upon the receptor status of the primary tumour. However, retrospective studies have shown significant discordance in receptor expression between primary and metastatic tumours. Therefore, the aim of this study was to prospectively assess the incidence of discordant receptor status in primary and metastatic disease and evaluate the role of bone marrow biopsies for the reassessment of receptor status.
Nine patients with known bone metastases were assessed with both a radiologically guided bone biopsy and a bone marrow aspirate and trephine. The oestrogen receptor and progesterone receptor status of these samples was assessed and compared with the primary breast cancer. Bone and bone marrow samples were also evaluated for HER2/neu status and compared with the status of the primary tumour if available.
Tumour cells were found in six of the nine bone metastasis specimens and five of the nine bone marrow samples. A discordance rate for the oestrogen receptor was seen in five of nine patients (56%) and for the progesterone receptor in four patients (44%). There seemed to be a correlation between bone and bone marrow biopsies.
The receptor discordance rate in this study was similar to previous retrospective studies. It seems that bone marrow biopsy may be a simple, safe and well-tolerated way to obtain tissue to reassess the receptor status of metastatic breast cancer.
乳腺癌骨转移的治疗传统上基于原发肿瘤的受体状态。然而，回顾性研究表明原发肿瘤与转移肿瘤之间的受体表达存在显著不一致。因此，本研究的目的是前瞻性评估原发疾病和转移疾病中受体状态不一致的发生率，并评估骨髓活检在重新评估受体状态中的作用。
对9例已知骨转移患者进行了放射学引导下的骨活检以及骨髓穿刺和活检。评估这些样本的雌激素受体和孕激素受体状态，并与原发性乳腺癌进行比较。还评估了骨和骨髓样本的HER2/neu状态，并在可能的情况下与原发肿瘤的状态进行比较。
在9个骨转移标本中的6个以及9个骨髓样本中的5个中发现了肿瘤细胞。9例患者中有5例（56%）出现雌激素受体不一致率，4例患者（44%）出现孕激素受体不一致率。骨活检和骨髓活检之间似乎存在相关性。
本研究中的受体不一致率与先前的回顾性研究相似。骨髓活检似乎可能是一种获取组织以重新评估转移性乳腺癌受体状态的简单、安全且耐受性良好的方法。
