Occult breast cancer (OBC) is uncommon, ranging from 0.1% to 0.8% of all diagnosed cases. Isolated axillary lymph node involvement due to unidentified carcinoma metastasis in the breast on clinical or radiological examination is the most common finding. Prognosis is usually similar to other tumors with the same clinical staging and immunohistochemical features, described as a T0 N1,2 or 3, M0.
KeywordsOccult breast carcinoma Immunohistochemical Surgical management Axillary dissection Radiation therapy
- 1.De Bresser J, de Vos B, van der Ent F, Hulsewé K. Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review. Eur J Surg Oncol. 2010;36:114–9. Systematic literature review on the clinical MRI employment regarding breast cancer, which included eight retrospective studies, encompassing 250 patients. CrossRefGoogle Scholar
- 2.Francisco M, Joseph J, Flynn J, Michael J, Vljay K. Optimal surgical management for occult breast carcinoma: a meta analysis. Ann Surg Oncol. 2016. A 8 studies meta-analysis encompassing 241 patients, of which 94 (39%) underwent axillary dissection with radiotherapy, 112 (46.5%) underwent mastectomy, and 35 (14.5%) underwent solely axillary dissection. Average follow-up was 61.8 months. Radiotherapy decreases loco-regional recurrence and, possibly, mortality rates of patients submitted to axillary dissection. Google Scholar
- 3.Galimberti V, Bassani G, Monti S, Simsek S, Villa G, Renne G, Luini A. Clinical experience with axillary presentation breast cancer. Breast Cancer Res Treat. 2004;88(1):43–7. Experience of the European Oncology Institute encompassing 50 patients committed by OBC. After careful evaluation of the breast by MRI, ultrasound and MMG, 23 subclinical lesions were identified, submitted to quadrantectomy + RT, followed by a tumoral focus identification in solely 12 patients (24%). Twenty-seven patients without subclinical lesions were submitted to RT and axillary dissection. After a 41.3 months follow-up, 39 patients (84%) were free of distant metastasis, 2 patients had local recurrences and 5 deaths were accounted due to cancer. CrossRefGoogle Scholar
- 4.Lu H, Xu YL, Zhang SP, Lang RG, Zee CS, Liu PF, Fu L. Breast magnetic resonance imaging in patients with occult breast carcinoma: evaluation on feasibility and correlation with histopathological findings. Chin Med J. 2011;124(12):1790–5. Study encompassing 35 patients. 21 presented visible lesions in MRI. Sensitivity, specificity, and accuracy of MRI to detect primary malignancy were 95.2%, 71.4% and 85.7%, respectively. Invasive ductal carcinoma accounted for 81% (17/21). Estrogen receptor was positive in 46.9% (15/32), progesterone in 34.4% (11/32), Her-2 expressed in 43.8% (14/32) and 37.5% (12/32) were triple-negative. PubMedGoogle Scholar
- 5.Walker G, Smith G, Perkins G, Oh J, Woodward W, Yu T, et al. Population-based analysis of occult primary breast Cancer with axillary lymph node metastasis. Cancer. 2010;116:4000–6. SEER data review encompassing 750 cases of occult breast carcinoma. The study compared prognosis according to their classification and further treatment. The overall survival after 10 years was 64.9% regarding radical mastectomy or axillary lymphadenectomy with radiotherapy group and 47.5% for the non-treated patients (p = 0.04). It also concludes that mastectomy presents similar results to conservative breast therapy (p = 0.79). CrossRefGoogle Scholar