Metastatic breast cancer: mechanisms and opportunities for cytology

Authors

  • D. Martins,

    1. IPATIMUP – Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
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  • F. Beca,

    1. IPATIMUP – Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
    2. Department of Medical Oncology, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
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  • F. Schmitt

    Corresponding author
    1. IPATIMUP – Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
    2. Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
    3. Department of Pathology, University Health Network, Toronto, ON, Canada
    • Correspondence:

      F. Schmitt, Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11E-215B, Toronto, ON, M5G 2C4, Canada

      Tel.: +1 (416) 340-3530; Fax: +1 (416) 340-5517;

      E-mail: fernando.schmitt@uhn.ca

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Abstract

Despite significant advances in diagnosis, surgical techniques, general patient care, and local and systemic adjuvant therapies, metastatic disease remains the most critical condition limiting the survival of patients with breast cancer. Therefore, the development of effective treatment against late-arising metastasis has become the centre of clinical attention and is one of the current challenges in cancer research. A deeper understanding of the metastatic cascade is fundamental, and the need for repetitive tumour assessments for the evaluation of tumour evolution is a relatively new practice in routine medical care. As such, fine needle aspiration cytology (FNAC) is ideally placed to monitor biological changes in metastasis that may affect treatment and response. As FNAC is a minimally invasive method, it can be performed repeatedly with relatively little trauma, and selective ancillary tests can be applied to FNAC specimens, including for tumour whose primary nature is known. Herein, we review how the linear and parallel models explain metastatic dissemination, thus influencing therapeutic and clinical decisions, and how cytology, together with immunocytochemistry and molecular analysis, can be a tool for routine clinical practice and clinical trials aimed at metastatic disease with a special emphasis on breast cancer.

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