Hellenic Journal of Surgery

, Volume 90, Issue 1, pp 33–35 | Cite as

Management of Occult Breast Cancer with Axillary Involvement

Review Article
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Abstract

Occult breast cancer (OBC), which is defined as clinically recognizable axillary metastatic carcinoma from an undetectable primary breast tumor, accounts for less than 1% of all patients who present with breast cancer (BC). Although criticized for high false positive rate (FPR) in routine BC diagnosis, the role of magnetic resonance imaging (MRI) is crucial in the diagnosis of OBC. The standard treatment for OBC, initially, was blind modified radical mastectomy, but one third of patients who undergo blind mastectomy, will have no histopathological findings of carcinoma. Current evidence supports the use of whole breast radiotherapy (WBRT) and axillary nodes clearance (ANC) as the locoregional treatment for patients with OBC. Management of the axilla does not differ from that of patients with BC with clinically palpable axillary lymph nodes (LNs) and ANC, which remains the gold standard, should be used for staging and loco-regional control. Neo-adjuvant chemotherapy (NACT) could reduce ANC by 43%, and for patients who undergo NACT with complete radiological response, a more conservative surgical approach, with a minimum of 3 sentinel lymph node biopsies (SLNBs), together with targeted dissection of the involved LNs could be considered as an option. This offers adequate staging and loco-regional control, combined with significantly less comorbidities than ANC. Overall, the prognosis of OBC is equal to or better than that of other BCs with metastasis to the axillary LNs. Progesterone receptor (PR) expression should be taken into account when evaluating the prognosis of OBC because PR-positive patients achieve better overall survival and have a lower risk of local recurrence. Surveillance should include breast MRI and mammography.

Keywords

Cancer breast occult axillary involvement management 

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References

  1. 1.
    Halsted WS. The results of radical operations for the cure of carcinoma of the breast. Ann Surg 1907;46:1–19.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Baron PL, Moore MP, Kinne DW, et al. Occult breast cancer presenting with axillary metastases. Updated management. Arch Surg 1990;125:210–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Patel J, Takuma N, Dutau R, et al. Axillary lymph node metastasis from an occult breast cancer. Cancer 1981;47: 2923–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Copeland EM, McBride CM. Axillary metastases from unknown primary sites. Ann Surg 1973;178:25–7.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Varadarajan R, Edge SB, Yu I, et al. Prognosis of occult breast carcinoma presenting as isolated 40_axillary nodal metastasis. Oncology 2006;71:456–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Abbruzzese JL, Abbruzzese MC, Hess KR, et al. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol 1994;12:1272–80.CrossRefPubMedGoogle Scholar
  7. 7.
    Hainsworth JD, et al. Management of patients with cancer of unknown primary site. Oncology (Williston Park) 2000;14:563–74.Google Scholar
  8. 8.
    Brill KL, Brenin DR. Occult breast cancer and axillary mass. Curr Treat Options Oncol 2001;2:149–55.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    Colfry AJ. Surgical Clinics of North America. Philadelfia, Pensilvania: Elsevier; 2013. pp.520.Google Scholar
  11. 11.
    Cameron HC. Some clinical facts regarding mammary cancer. BMJ 1909;1:577–82.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Foroudi F, Tiver KW. Occult breast carcinoma presenting as axillary metastases. Int J Radiat Oncol Biol Phys 2000:47: 143–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Shannon C, Walsh G, Sapunar F, et al. Occult primary breast carcinoma presenting as axillary lymphadenopathy. Breast 2002;11:414–8.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    Vilcoq JR, Calle R, Ferme F, et al. Conservative treatment of axillary adenopathy due to probable subclinical breast cancer. Arch Surg 1982;117:1136–8.CrossRefPubMedGoogle Scholar
  16. 16.
    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;8:425–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Hessler LK, et al. Factors Influencing management and outcome in patients with occult breast cancer with axillary lymph node involvement: Analysis of the National Cancer Database. Ann Surg Oncol 2017;10:2907–14.CrossRefGoogle Scholar
  18. 18.
    Campana F, Fourquet A, Ashby MA, et al. Presentation of axillary lymphadenopathy without detectable breast primary (T0 N1b breast cancer): Experience at Institut Curie. Radiotherapy Oncol 1989;15:321–5.CrossRefGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    Abe H, Naitoh H, Umeda T, et al. Occult breast cancer presenting axillary nodal metastasis: a case report. Jpn J Clin Oncol 2000;30:185–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: The ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013;310:1455–61.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Dominici LS, Negron Gonzalez VM, Buzdar AU, et al. Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2-positive breast cancer. Cancer 2010;116:2884–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Claude AS, et al. Predicting the extent of nodal disease in early-stage breast cancer. Ann Surg Oncol 2014;21:3440–7.CrossRefGoogle Scholar
  24. 24.
    Zhu Y, Luo M, Jia Z, et al. Diagnoses and therapy of occult breast cancer: A Systematic Review. J Mol Biomark Diagn 2016;S2:023.Google Scholar
  25. 25.
    Caudle AS, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: Implementation of targeted axillary dissection. J clin Oncol 2016;34:1072–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Wang J, et al. Treatment outcomes of occult breast carcinoma and prognostic analyses. Chin Med J (Engl) 2013;126:3026–9.Google Scholar
  27. 27.
    Santen RJ, et al. Effects of menopausal hormonal therapy on occult breast tumors. J Steroid Biochem Mol Biol 2013;137:150–6.CrossRefPubMedGoogle Scholar

Copyright information

© Hellenic Surgical Society and Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Guy’s and St Thomas’ NHS Foundation Trust and King’s College, London, United Kingdom; Department of Anatomy and Surgical AnatomyUniversity of Athens Medical SchoolAthensGreece

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