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Breast Conservation in the Setting of Contemporary Multimodality Treatment Provides Excellent Outcomes for Patients with Occult Primary Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate recurrence and survival for patients with occult (T0N+) breast cancer who underwent contemporary treatment, assessing outcomes for breast conservation and mastectomy.

Methods

We performed a single-institution review of women with occult breast cancer presenting with axillary metastasis without identifiable breast tumor or distant metastasis. We excluded patients with tumors in the axillary tail or mastectomy specimen, patients with additional nonbreast cancer diagnoses, and patients with a history of breast cancer. Breast conservation was defined as axillary node dissection with radiation therapy, without breast surgery. We evaluated patient, tumor, treatment, and outcome variables. Patients were assessed for local, regional, and distant recurrences. Overall survival was calculated using the Kaplan–Meier method.

Results

Thirty-six patients met criteria for occult breast cancer. Most of these patients (77.8 %) had N1 disease. Fifty percent of cancers (n = 18) were estrogen receptor–positive; 12 (33.3 %) were triple-negative. All patients were evaluated with mammography. Thirty-five patients had breast ultrasound (97.2 %) and 33 (91.7 %) had an MRI. Thirty-four patients (94.4 %) were treated with chemotherapy and 33 (91.7 %) with radiotherapy. Twenty-seven patients (75.0 %) were treated with breast conservation. The median follow-up was 64 months. There were no local or regional failures. One distant recurrence occurred >5 years after diagnosis, resulting in a 5-years overall survival rate of 100 %. There were no significant survival differences between patients receiving breast conservation versus mastectomy (p = 0.7).

Conclusions

Breast conservation—performed with contemporary imaging and multimodality treatment—provides excellent local control and survival for women with T0N+ breast cancer and can be safely offered instead of mastectomy.

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References

  1. Baron PL, Moore MP, Kinne DW, et al. Occult breast cancer presenting with axillary metastases. Updated management. Arch Surg. 1990;125:210–4.

    Article  CAS  Google Scholar 

  2. Kemeny MM, Rivera DE, Terz JJ, Benfield JR. Occult primary adenocarcinoma with axillary metastases. Am J Surg. 1986;152:43–7.

    Article  CAS  PubMed  Google Scholar 

  3. Culine S. Prognostic factors in unknown primary cancer. Semin Oncol. 2009;36:60–4.

    Article  CAS  PubMed  Google Scholar 

  4. Rosen PP, Kimmel M. Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients. Hum Pathol. 1990;21:518–23.

    Article  CAS  PubMed  Google Scholar 

  5. National Comprehensive Cancer Network: Clinical practice guidelines in oncology. 2014. http://www.nccn.org. Accessed 27 April 2014.

  6. Khandelwal AK, Garguilo GA. Therapeutic options for occult breast cancer: a survey of the American Society of Breast Surgeons and review of the literature. Am J Surg. 2005;190:609–13.

    Article  PubMed  Google Scholar 

  7. Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D. Axillary metastatic disease as presentation of occult or contralateral breast cancer. Breast. 2009;18:225–7.

    Article  CAS  PubMed  Google Scholar 

  8. Walker GV, Smith GL, Perkins GH, et al. Population-based analysis of occult primary breast cancer with axillary lymph node metastasis. Cancer. 2010;116:4000–6.

    Article  PubMed  Google Scholar 

  9. American Joint Committe on Cancer: Cancer staging handbook from the AJCC cancer staging manual. 2010. http://www.cancerstaging.org. Accessed 27 April 2014.

  10. Ellerbroek N, Holmes F, Singletary E, et al. Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin. Cancer. 1990;66:1461–7.

    Article  CAS  PubMed  Google Scholar 

  11. Merson M, Andreola S, Galimberti V, et al. Breast carcinoma presenting as axillary metastases without evidence of a primary tumor. Cancer. 1992;70:504–8.

    Article  CAS  PubMed  Google Scholar 

  12. Valero V, Buzdar AU, McNeese M, et al. Primary chemotherapy in the treatment of breast cancer: the University of Texas M. D. Anderson Cancer Center experience. Clin Breast Cancer. 2002;3 Suppl 2:S63–8.

    Article  PubMed  Google Scholar 

  13. Cance WG, Carey LA, Calvo BF, et al. Long-term outcome of neoadjuvant therapy for locally advanced breast carcinoma: effective clinical downstaging allows breast preservation and predicts outstanding local control and survival. Ann Surg. 2002;236:295–302; discussion 293–302.

  14. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  15. Brill KL, Brenin DR. Occult breast cancer and axillary mass. Curr Treat Options Oncol. 2001;2:149–55.

    Article  CAS  PubMed  Google Scholar 

  16. Foroudi F, Tiver KW. Occult breast carcinoma presenting as axillary metastases. Int J Radiat Oncol Biol Phys. 2000;47:143–7.

    Article  CAS  PubMed  Google Scholar 

  17. Shannon C, Walsh G, Sapunar F, et al. Occult primary breast carcinoma presenting as axillary lymphadenopathy. Breast. 2002;11:414–8.

    Article  PubMed  Google Scholar 

  18. Vlastos G, Jean ME, Mirza AN et al. Feasibility of breast preservation in the treatment of occult primary carcinoma presenting with axillary metastases. Ann Surg Oncol. 2001;8:425–431.

    Article  CAS  PubMed  Google Scholar 

  19. Fowble B, Gray R, Gilchrist K, et al. Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy. J Clin Oncol 1988;6:1107–17.

    CAS  PubMed  Google Scholar 

  20. Whillis D, Brown PW, Rodger A. Adenocarcinoma from an unknown primary presenting in women with an axillary mass. Clin Oncol (R Coll Radiol). 1990;2:189–92.

    Article  CAS  PubMed  Google Scholar 

  21. Buchanan CL, Morris EA, Dorn PL, et al. Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol. 2005;12:1045–53.

    Article  PubMed  Google Scholar 

  22. Chen C, Orel SG, Harris E, et al. Outcome after treatment of patients with mammographically occult, magnetic resonance imaging-detected breast cancer presenting with axillary lymphadenopathy. Clin Breast Cancer. 2004;5:72–7.

    Article  PubMed  Google Scholar 

  23. McMahon K, Medoro L, Kennedy D. Breast magnetic resonance imaging: an essential role in malignant axillary lymphadenopathy of unknown origin. Australas Radiol. 2005;49:382–9.

    Article  CAS  PubMed  Google Scholar 

  24. Morris EA, Schwartz LH, Dershaw DD et al. MR imaging of the breast in patients with occult primary breast carcinoma. Radiology. 1997;205:437–40.

    Article  CAS  PubMed  Google Scholar 

  25. Obdeijn IM, Brouwers-Kuyper EM, Tilanus-Linthorst MM, et al. MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast. AJR Am J Roentgenol. 2000;174:1079–84.

    Article  CAS  PubMed  Google Scholar 

  26. Olson JA Jr., Morris EA, Van Zee KJ et al. Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Ann Surg Oncol. 2000;7:411–5.

    Article  PubMed  Google Scholar 

  27. Orel SG, Weinstein SP, Schnall MD et al. Breast MR imaging in patients with axillary node metastases and unknown primary malignancy. Radiology. 1999;212:543–9.

    Article  CAS  PubMed  Google Scholar 

  28. Vilcoq JR, Calle R, Ferme F, Veith F. Conservative treatment of axillary adenopathy due to probable subclinical breast cancer. Arch Surg. 1982;117:1136–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We have no financial disclosures or sources of support.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA

    Natasha M. Rueth MD, MS, Dalliah M. Black MD, Angela R. Limmer MS, PA, Emmanuel Gabriel MD, PhD, Min Yi MD, PhD & Kelly K. Hunt MD

  2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Lei Huo MD

  3. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bruno D. Fornage MD & Basak E. Dogan MD

  4. Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariana Chavez-MacGregor MD, MS

  5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Eric A. Strom MD

Authors
  1. Natasha M. Rueth MD, MS
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  2. Dalliah M. Black MD
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  3. Angela R. Limmer MS, PA
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  4. Emmanuel Gabriel MD, PhD
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  5. Lei Huo MD
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  6. Bruno D. Fornage MD
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  7. Basak E. Dogan MD
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  8. Mariana Chavez-MacGregor MD, MS
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  9. Min Yi MD, PhD
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  10. Kelly K. Hunt MD
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  11. Eric A. Strom MD
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Corresponding author

Correspondence to Dalliah M. Black MD.

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Rueth, N.M., Black, D.M., Limmer, A.R. et al. Breast Conservation in the Setting of Contemporary Multimodality Treatment Provides Excellent Outcomes for Patients with Occult Primary Breast Cancer. Ann Surg Oncol 22, 90–95 (2015). https://doi.org/10.1245/s10434-014-3991-0

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  • DOI: https://doi.org/10.1245/s10434-014-3991-0

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