Optimal Surgical Management for Occult Breast Carcinoma: A Meta-analysis

Macedo, Francisco Igor B.; Eid, Joseph J.; Flynn, Jeffrey C.; Jacobs, Michael J.; Mittal, Vijay K.

doi:10.1245/s10434-016-5104-8

Cited by 55 publications

(35 citation statements)

References 24 publications

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“…9 In the current study, occult breast cancer represented less than 0.5% of breast cancers surgically treated at our center during the study period. The application of breast MRI as a routine component of the evaluation of patients in whom mammography and ultrasound have been unable to locate a breast primary will undoubtedly further diminish the frequency with which women with truly imaging occult breast cancers are identified.…”

Section: Discussionmentioning

confidence: 69%

“…Occult breast cancer was defined as adenocarcinoma histologically consistent with a breast origin that presented with axillary metastases in the absence of primary breast tumor on physical examination, imaging, or preoperative biopsy. 9 Patients eligible for inclusion were those who presented with biopsy proven axillary lymph node metastases and were evaluated with a breast MRI prior to definitive axillary surgery. All MRI studies prior to July 2009 were performed on a 1.5T MRI scanner after which both 1.5T and 3T MRI scanners were used within the department.…”

Section: Methodsmentioning

confidence: 99%

“…Axillary lymph node dissection (ALND) followed by whole-breast radiotherapy (WBRT) has emerged as a viable treatment option. 6–8 A recent meta-analysis identified studies comprising only 241 patients of whom less than half had a preoperative breast MRI 9 , and concluded that equivocal rates of local control and overall survival are achievable with breast ALND and WBRT. 10 Notwithstanding this, population studies suggest that almost half of patients with occult breast are still treated with MRM.…”

Section: Introductionmentioning

confidence: 99%

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Oncologic Outcomes After Treatment for MRI Occult Breast Cancer (pT0N+)

et al. 2017

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Background Studies assessing outcomes in occult breast cancer have often included women treated before the routine use of MRI. We undertook to examine outcomes in patients presenting with axillary adenopathy and no primary detectable on MRI or other imaging modalities. Methods All patients with axillary nodal metastases consistent with breast carcinoma, and no detectable breast primary on physical exam, mammography, or MRI treated between 1/1/1996 and 6/30/2011 were identified from an institutional database. Data was collected on local, regional, and distant recurrences. Results Thirty-eight patients were identified. Modified radical mastectomy (MRM) was performed in 13, while 25 underwent axillary dissection (ALND) and whole-breast radiotherapy (WBRT). Most women had pathological N1 disease (median number of positive nodes 2 [MRM cohort] and 3 [ALND+WBRT cohort], p=0.38). All patients received chemotherapy, with 30 of the 38 patients (79%) treated receiving an anthracycline and taxane. Regional nodal radiation was used in 60% of those with ALND+WBRT and in all of the 46% of MRM patients who received chest wall radiotherapy. At a median follow up of 7 years, there were no nodal recurrences. Two patients treated with ALND+WBRT developed in-breast recurrences; none in the MRM group developed local recurrence. The proportion that developed distant disease was similar between the MRM cohort (1 of 13) and the ALND+WBRT cohort (2 of 25). Conclusion Breast cancer presenting as axillary adenopathy but no detectable primary is rare. Breast conservation with WBRT is a viable option for patients diagnosed with occult breast cancer and a negative preoperative MRI.

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Section: Discussionmentioning

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oncologic Outcomes After Treatment for MRI Occult Breast Cancer (pT0N+)

et al. 2017

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“…However, the mortality and local recurrence of ALND+XRT are better than those of ALND alone. Therefore, it suggests that ALND combined with XRT may be the best choice for surgical treatment of occult breast cancer (Macedo et al, 2016).…”

Section: Treatmentmentioning

confidence: 99%

The Research Progress of Occult Breast Cancer

Guo¹,

Zhai²,

Li³

et al. 2017

cge

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Occult breast cancer (OBC) is a rare special type of breast cancer. Clinically, the lumps of axillary lymph node is the first symptom, but hard to palpate of breast lumps. All the time, occult breast cancer cases are less. Clinical diagnosis is very difficult. Pathological examination of axillary lymph node puncture combined with immunohistochemistry and imaging examination can improve preoperative diagnosis of the disease.

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“…Observed rates of locoregional failure in patients who receive ALND only without treatment to the ipsilateral breast are high implying the need for treatment of the ipsilateral breast. A small number of comparative, non-randomized trials, recently collated as a meta-analysis, have demonstrated similar rates of both locoregional recurrence and overall survival in patients treated with ALND and mastectomy to those treated with ALND and whole-breast radiotherapy (19). Therefore, whole-breast radiotherapy is a breast-conserving alternative to mastectomy in these patients.…”

Section: Management Of the Axilla In Special Circumstancesmentioning

confidence: 99%

Current Management of the Axilla

McCartan

Gemignani²

2016

Clinical Obstetrics &Amp; Gynecology

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Despite advances in estimating prognosis and predicting response to adjuvant systemic therapy, the status of the axillary lymph nodes remains a critical component in initial surgical planning and in determining therapeutic strategies for patients with breast cancer. Buoyed by evidence from multi-institutional randomized clinical trials, the last two decades have witnessed remarkable and practice-changing advances in our approach to the axilla. This review concentrates on the current best practice in axillary management for both node-negative and node-positive patients with particular focus on the evolving management of the axilla in the era of neoadjuvant systemic therapy.

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Optimal Surgical Management for Occult Breast Carcinoma: A Meta-analysis

Cited by 55 publications

References 24 publications

Oncologic Outcomes After Treatment for MRI Occult Breast Cancer (pT0N+)

Oncologic Outcomes After Treatment for MRI Occult Breast Cancer (pT0N+)

The Research Progress of Occult Breast Cancer

Current Management of the Axilla

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