No abstract

SLN biopsy should be considered as a standard procedure in DCISM patients. SLNB can detect nodal micrometastasis and accurately stage the axilla avoiding the morbidity of a CAD. Complete AD may not be mandatory if only the SLN contains micrometastatic disease. Informed consent is very important in the decision not to undergo CAD.

We present our experience of 50 cases of occult primary tumours presenting as axillary metastases, all with histological report of adenocarcinoma compatible with mammary carcinoma. After bilateral US and mammography, with MRI and mammoscintigraphy where necessary, ipsilateral breast cancer was suspected in 23 cases and quadrantectomy performed. Breast cancer was found only in 12 (24%). In the other 27 women there was no clinical or instrumental suspicion of breast cancer or other primary disease site, so the main treatment was complete axillary dissection plus radiotherapy to the ipsilateral breast (given to all patients). Chemotherapy alone was given to 27 patients, hormone treatment to 5 patients, and both to 18. Mean follow-up is 41.3 months (range 108-1). Thirty-nine (84%) patients are alive with no evidence of disease, two are alive with breast disease, five patients have died of metastatic disease (with no evidence breast disease). Our experience, like that of the literature, confirms that the breast should be extensively investigated but that blanket investigations are not usually revealing. We present guidelines for the work-up of patients presenting with axillary disease.

No abstract

In women previously irradiated for Hodgkin's disease, ELIOT could avoid repeat irradiation of the whole breast, thereby permitting conservative surgical treatment.