Biopsy Safety/Efficacy

Hi, friend!

This week I got a question from someone I’m working with who wanted to know if a biopsy was necessary to figure out if a bump under her skin was cancerous or just a sign of detoxification. I started researching alternatives to biopsies and found some interesting information on alternative, noninvasive testing options. Then I looked up the dangers of biopsies (namely, seeding), and what may be some ways to reduce seeding if a person chooses to move forward with a biopsy.

So here we go! Let’s start with the principle, “First, do no harm.” What harm could come from a biopsy?

Well, unfortunately, cancer cells can be broken off of a tumor and disseminated into surrounding tissues, either lodging locally or distally. I found 12 articles just on melanoma and seeding. (5-12)

What causes seeding of cancerous cells?

It appears that different changes in the cancer cell must occur before it metastasizes to surrounding areas. For one, it has to be able to stick to other cells, it must be able to produce enzymes that break down the tissues around it so it can move about. It also must have an environment that supports its growth. (Is the body generally hospitable to cancer? Is the immune system suppressed? Is there inflammation, swelling and/or overgrowth of bacteria, fungi, viruses?) (1)

Other factors that contribute to seeding include the actual physical removal of the tumor or biopsy, including unnecessary damage to the tissue through poor technique or slipping of the surgical tools. (2)

If a person decides to move forward with a biopsy, however, what can be done to help reduce the risk of seeding?

An interesting idea to prevent seeding is to zap the surrounding environment with electricity! This can create a toxic environment that in theory will not allow the cancer to grow. This has been tested and observed in meat (in which the pH rises) and bacterial cells (in place of cancer cells, which often seem to go hand in hand) were killed. However, this hasn’t been demonstrated in human cells, as far as I’m aware. (3)

High dose vitamin C (along with EGCG from green tea and L-lysine and L-proline) may also help by aiding in the prevention of the breakdown of collagen, which serves as glue between cells and prevents metastasis.

To address the environment around the tumor, one can create a healthy, balanced, clean bodily tissues through the use of diet therapies like the Gerson Therapy or Square One protocol!

Modified citrus pectin (PectaSol is the brand I used) has also been shown to prevent metastasis by inhibiting galectin-3’s action in blood vessel growth and binding to breast cancer cells in this study. (4)

Or, are there options to avoid biopsy altogether? Here’s what I found for skin cancer diagnostic testing...

“Recently, many innovative skin cancer detection technologies have been developed to increase diagnostic accuracy for skin cancers.

Such technologies include reflectance confocal microscopy, optical coherence tomography, High frequency ultrasound, multispectral digital skin lesion analysis, electrical impedance spectroscopy, Raman spectroscopy, multiphoton tomography, and the pigmented skin lesion assay.  The new technologies are beneficial because they are fast and noninvasive, provide comprehensive imaging of the lesion, allow for remote diagnosis, and provide high sensitivity.”

Because “The new technologies are limited by high expense, the need for trained operators and interpreters, anatomic limitations, and low specificity,” (18) I chose to focus on one test that is likely to be one of the more widely available options: high frequency ultrasound. I found four studies (19-22) on high frequency ultrasound and skin cancers which suggested that it is a fairly reliable test. Depending on the circumstance, if ruling out a potential melanoma diagnosis I may not leave my fate in the hands of one test but may also consider blood tests including LDH, maybe S-100 (which usually indicates later stage melanomas) and/or possibly a circulating tumor cell count test if I had and wanted to spend the resources on that.

I referred my friend to someone somewhat local, Dr. Bard in NYC, who authored 3 of the 4 studies just mentioned (19-22).

On the flip side, interestingly, there are spontaneous remissions of cancer following biopsy! I list 9 articles on such occurrences in various types of cancer at the end of this article (23-31),  though there are more that I just didn’t list. (In melanoma, by the way, spontaneous remissions seemed to occur more frequently in shave biopsies rather than punch biopsies.) Wound healing may play a role, in which the immune system comes to clean up the wound, then it produces antibodies to the antigens on the tumor cells, and just keeps attacking the cancer cells until they’re gone. (You can search: "spontaneous biopsy remission" on PubMed to find more articles.)

Practically speaking, in real life whether biopsy actually leads to metastasis and/or remission, I found a few people on Facebook who said that their cancer spread after a biopsy, and got to hear back from one of them that she had not yet started an intensive healing protocol when she had her biopsy. I have an idea (which I first heard from my friend Gar) that the environment, as stated above, of the bodily tissues surrounding the tumor and in the rest of the body, may play a role in whether a cancer seeds, does nothing, or is eliminated by the immune system following biopsy. Dr. Polly Matzinger, “inventor” of the Danger Theory/Model of the immune system, once found skin cancer (I think it was basal cell carcinoma) on her nose, scratched it with a nickel earring because she knew she was allergic to it, and the skin cancer spontaneously regressed! I can’t recall when/where she said that but it may have been in one of her lectures at NIH.

Well, friend, I hope that helps you be informed and have a place to start your research on the pros and cons of tumor biopsies! Please let me know if you have any questions.

Enjoy your weekend!


Bailey :)

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  1. [Mechanisms of metastasis]

  2. Tumor cell dissemination during laparoscopy: prevention and therapeutic opportunities

  3. Electrochemical prevention of needle-tract seeding

  4. Inhibition of human cancer cell growth and metastasis in nude mice by oral intake of modified citrus pectin

Melanoma Seeding (spreading) Articles/Cases (5-17)

  1. A case of melanoma seeding along the biopsy tract

  2. Tumour seeding along needle biopsy tract in pancreatic cancer

  3. Papillary Renal Cell Carcinoma Seeding along a Percutaneous Biopsy Tract

  4. Neoplastic seeding of breast cancer along the core biopsy tract

  5. Are Biopsy Tracts a Concern for Seeding and Local Recurrence in Sarcomas?

  6. Seeding of osteosarcoma in the biopsy tract of a patient with multifocal osteosarcoma

  7. Implantation Metastasis along the Stereotactic Biopsy Tract in Anaplastic Astrocytoma: A Case Report

  8. Implantation metastasis of malignant fibrous histiocytoma along the stereotactic biopsy tract

  9. Metastatic seeding of glioblastoma along image-guided biopsy tract with successful treatment with re-irradiation: A case report

  10. Tumor seeding along the needle track after percutaneous lung biopsy

  11. Limiting tumor seeding as a therapeutic approach for metastatic disease

  12. Serious tumor seeding after brainstem biopsy and its treatment-a case report and review of the literature

  13. Effects of biopsy-induced wound healing on residual basal cell and squamous cell carcinomas: rate of tumor regression in excisional specimens

In our series, 24% of NMSCs transected on the initial biopsy showed no residual tumor in the excision specimens, implying that some event in the interval between biopsy and excision may lead to the eradication of residual tumor. The exact mechanism is unclear, but wound healing likely plays an important role.

Skin cancer detection technologies (18-22)

  1. Skin Cancer Detection Technology

  2. High-Frequency Ultrasound Examination in the Diagnosis of Skin Cancer (Dr. Bard, 2017)

(20) Ultrasound in dermatology: principles and applications (Dr. Bard, 2012)

(21) Skin cancer: findings and role of high-resolution ultrasound (Dr. Bard, 2019)

“Moreover, post-surgical surveillance of high-risk cases allows an early detection of local or nodal recurrence [30]. It is, however, our experience that, with some notable exceptions, US is underemployed by dermatologists and surgeons in the assessment of skin tumors and that more efforts are needed to make spread this US application worldwide.”

(22) Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia

(Other authors, 2014) “The sensitivity and specificity of ultrasound for identifying malignant superficial soft-tissue tumors was 94.1% and 99.7%, respectively.”

Spontaneous remission following biopsy (23-31)

(23) Spontaneous remission of untreated primary amyloidosis of the bladder after transurethral resection biopsy: a case report and literature review

(24) Spontaneous remission in diffuse large cell lymphoma: a case report

(25) Spontaneous regression of primary renal cell carcinoma following image-guided percutaneous biopsy

(26) Spontaneous regression of two giant basal cell carcinomas in a single patient after incomplete excision

(27) Spontaneous regression of a primary squamous cell lung cancer following biopsy: a case report

(28) Spontaneous regression of non-small cell lung cancer after biopsy of a mediastinal lymph node metastasis: a case report

(29) Spontaneous regression of canine papillomavirus type 2-related papillomatosis on footpads in a dog

(Not cancer, and in dogs, but very interesting nonetheless!)

"Two weeks after a biopsy, the skin lesion spontaneously regressed without any specific treatment. In non-immunocompromised dogs, CPV-2-related footpad papillomatosis could spontaneously resolve after a biopsy."

(30) Case Report of Spontaneous Resolution of a Congenital Glioblastoma

"We describe the first known report of spontaneous resolution of a congenital GBM without any systemic therapy. A limited debulking procedure was performed at diagnosis, and the residual tumor underwent spontaneous resolution over the following 21 months. The patient remains in remission, with no tumor recurrence after 5 years of follow-up."

(31) A case of CD4 +/CD8 + double-positive primary cutaneous anaplastic large cell lymphoma of the lip involving spontaneous regression after biopsy