Factors Influencing Management and Outcome in Patients with Occult Breast Cancer with Axillary Lymph Node Involvement: Analysis of the National Cancer Database

Hessler, Lindsay K.; Molitoris, Jason K.; Rosenblatt, Paula; Bellavance, Emily; Nichols, Elizabeth M.; Tkaczuk, Katherine H.; Feigenberg, Steven J.; Bentzen, Søren M.; Kesmodel, Susan B.

doi:10.1245/s10434-017-5928-x

Cited by 35 publications

(36 citation statements)

References 16 publications

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“…However, in this study, the ALND-only group exhibited BCSS and OS rates similar to those of the BCS group and the mastectomy group, a result that was different from the majority of the published literature. 7 , 20 , 34 , 35 , 38 , 39 Only one study, conducted in Korea, supported our finding, with the explanation that the ALND-only group in their study population had a high prevalence of stage N3 disease. 6 In our study, potential explanations for this observation are that the ALND-only group included a limited number of patients (n=54) and had a higher proportion of patients with 1–3 positive LNs (57.41%, P =0.003).…”

Section: Discussionsupporting

confidence: 67%

“…Compared with non-OBC, this special type of breast cancer was associated with older age, a more advanced stage, a higher proportion of negative hormone receptor expression, a higher proportion of HER2-positive status, a greater likelihood of having ≥10 positive LNs, and a lower likelihood of surgical treatment; some of these associations were concordant with the findings of previous studies. 5 , 10 , 11 , 20 The higher proportion of negative ER and PR status in OBC than in non-OBC might be explained by the discordance in this status between the primary tumor and LN metastases. 21 , 22 Due to the absence of clinically, radiologically, or pathologically identifiable breast tumors, the receptor status in OBC patients was detected from the metastatic LNs.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, our analysis found that the SLND-only group had the worst survival rate, which suggests that the extent of LN examination and the type of locoregional therapy are important for OBC patients. 7 , 20 , 41 …”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Ge¹,

Liu²,

Xiao³

et al. 2018

CMAR

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BackgroundOccult breast cancer (OBC) is a rare type of breast cancer that has not been well studied. The clinicopathological characteristics and treatment recommendations for OBC are based on a limited number of retrospective studies and thus remain controversial.Patients and methodsWe identified 479 OBC patients and 115,739 non-OBC patients from 2004 to 2014 in and the Surveillance, Epidemiology, and End Results (SEER) database. The clinicopathological characteristics and survival outcomes were compared between OBC and non-OBC patients. We used the propensity score 1:1 matching analysis to evaluate OBC vs non-OBC comparison using balanced groups with respect to the observed covariates. We further divided the OBC population into four groups based on different treatment strategies. Univariable and multivariable analyses were used to calculate and compare the four treatment outcomes within the OBC population.ResultsOBC patients were older, exhibited a more advanced stage, a higher rate of negative estrogen receptor and progesterone receptor status, a higher rate of HER2-positive status, and a higher rate of ≥10 positive lymph nodes, and were less likely to undergo surgical treatment than non-OBC patients. After adjustments for clinicopathological factors, the OBC patients exhibited a significantly better survival than the non-OBC patients (P<0.001). This result was confirmed in a 1:1 matched case–control analysis. Within the four OBC treatment groups, we observed no difference in survival among the mastectomy group, the breast-conserving surgery (BCS) group, and the axillary lymph node dissection (ALND)-only group. The multivariable analysis revealed that the sentinel lymph node dissection-only group had the worst prognosis (P<0.001). Conclusion: OBC has unique clinicopathological characteristics and a favorable prognosis compared with non-OBC. BCS plus ALND and radiotherapy showed a survival benefit that was similar to that of mastectomy for OBC patients.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Ge¹,

Liu²,

Xiao³

et al. 2018

CMAR

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“…The management of the axilla is more controversial. The standard of care is axillary lymph node dissection (ALND), which provides detailed information on the number of involved nodes, accurate tumor staging and analysis of the expression of various receptors [6]. In the era of personalized treatment strategies, it is reasonable to consider a more minimal surgical approach for the management of the involved axilla, such as sentinel lymph node biopsy (SLNB) and excision of the marked metastatic node after neoadjuvant treatment.…”

Section: Editorialmentioning

confidence: 99%

Occult Breast Cancer: Is it Time to Minimize Surgical Intervention?

Ignatiadou

2018

Hellenic J Surg

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“…The incidence of the latter is 0.1–3%. It is thought that OBC is secondary to micro-invasive breast cancer [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Occult breast cancer: Where are we at?

Ofri¹,

Moore

2020

The Breast

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Occult breast cancer (OBC) is described as an axillary metastatic carcinoma without detection of a primary breast lesion and is uncommon. Significant advances in breast imaging have occurred since its description, decreasing its incidence. However current management is based upon old studies, with variable clinical, radiological and pathological definitions of OBC. We suggest standardised definitions of OBC to facilitate more homogenous data representation in the literature. This review also discusses the conflicting heterogeneous data and its influence in determining the current management guidelines. We discuss whether the current significant surgical recommendations are necessary and postulate whether they could be safely substituted with less invasive management.

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Factors Influencing Management and Outcome in Patients with Occult Breast Cancer with Axillary Lymph Node Involvement: Analysis of the National Cancer Database

Cited by 35 publications

References 16 publications

Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Occult Breast Cancer: Is it Time to Minimize Surgical Intervention?

Occult breast cancer: Where are we at?

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