Yoneyama Kimiyasu, Nakagawa Motohito, Hara Asuka
Department of Breast Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa 254-0065, Japan.
Int J Surg Case Rep. 2020;72:318-321. doi: 10.1016/j.ijscr.2020.06.013. Epub 2020 Jun 12.
Needle tract seeding is the implantation of tumor cells at the site of needle passage during needle biopsy. Histopathological examination of resected specimens after biopsy shows an incidence of 22%-50%. However, reports of actual local recurrence are extremely rare. Here we report such a case.
A 67-year-old woman was diagnosed with ductal carcinoma by histopathology and underwent right mastectomy and sentinel lymph node biopsy. Histopathological examination revealed non-invasive ductal carcinoma. One year after the first operation, a mass was found at the site of the core needle biopsy (CNB) scar near the previous surgical wound on the right chest. Histological examination revealed the tumor as adenocarcinoma, and a skin lesion resection was performed. After surgery, radiation therapy and endocrine therapy were performed. She remains relapse-free as of this writing, 9 months after resection.
Reports of local recurrence due to needle tract seeding are extremely rare. We found nine cases of mastectomy and seven cases of partial resection performed for the first surgery; six patients received radiation therapy and 10 did not. Histological diagnosis at the time of the first operation was invasive carcinoma in all cases.
The risk of seeding is high with multiple punctures in CNB, in cases with a short period until surgery, and in mucinous carcinoma. Considering these factors, CNB puncture should preferably be at a site that is included in the resection area during surgery. If not resected, close follow-up is necessary considering the possibility of local recurrence.
针道种植是指在针吸活检过程中肿瘤细胞在针道部位的植入。活检后切除标本的组织病理学检查显示发生率为22%-50%。然而，实际局部复发的报道极为罕见。在此我们报告这样一例病例。
一名67岁女性经组织病理学诊断为导管癌，接受了右乳房切除术和前哨淋巴结活检。组织病理学检查显示为非浸润性导管癌。首次手术后一年，在右胸先前手术伤口附近的粗针活检（CNB）瘢痕部位发现一个肿块。组织学检查显示肿瘤为腺癌，并进行了皮肤病变切除术。手术后，进行了放射治疗和内分泌治疗。截至撰写本文时，切除术后9个月，她仍未复发。
针道种植导致局部复发的报道极为罕见。我们发现首次手术行乳房切除术9例，部分切除术7例；6例患者接受了放射治疗，10例未接受。所有病例首次手术时的组织学诊断均为浸润性癌。
在CNB中多次穿刺、手术前时间短以及黏液腺癌的情况下，种植风险较高。考虑到这些因素，CNB穿刺最好在手术切除区域内的部位进行。如果不切除，考虑到局部复发的可能性，有必要密切随访。
