Outcome of breast-conserving treatment for axillary lymph node metastasis from occult breast cancer with negative breast MRI

Kim, Haeyoung; Park, Won; Kim, Su Ssan; Ahn, Sung‐Ju; Kim, Yong Bae; Kim, Tae Hyun; Kim, Jin Hee; Choi, Jin Hwa; Park, Hae Jin; Chang, Jee Suk; Choi, Doo Ho

doi:10.1016/j.breast.2019.10.017

Cited by 23 publications

(17 citation statements)

References 34 publications

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“…38,39 Patients with a negative MRI who underwent breast conservation treatment instead of mastectomy had 96% breast cancer-free survival in a multicenter study with a small risk of ipsilateral recurrence. 40…”

Section: Indications For Breast Mrimentioning

confidence: 99%

What’s Hot in Breast MRI

Scaranelo

2021

Can Assoc Radiol J

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Several articles in the literature have demonstrated a promising role for breast MRI techniques that are more economic in total exam time than others when used as supplement to mammography for detection and diagnosis of breast cancer. There are many technical factors that must be considered in the shortened breast MRI protocols to cut down time of standard ones, including using optimal fat suppression, gadolinium-chelates intravascular contrast administrations for dynamic imaging with post processing subtractions and maximum intensity projections (MIP) high spatial and temporal resolution among others. Multiparametric breast MRI that includes both gadolinium-dependent, i.e., dynamic contrast-enhanced (DCE-MRI) and gadolinium-free techniques, i.e., diffusion-weighted/diffusion-tensor magnetic resonance imaging (DWI/DTI) are shown by several investigators that can provide extremely high sensitivity and specificity for detection of breast cancer. This article provides an overview of the proven indications for breast MRI including breast cancer screening for higher than average risk, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision, detecting occult cancer in patients presenting with axillary node metastasis, detecting residual tumor after incomplete breast cancer surgical excision, detecting cancer when results of conventional imaging are equivocal, as well patients suspicious of having breast implant rupture. Despite having the highest sensitivity for breast cancer detection, there are pitfalls, however, secondary to false positive and false negative contrast enhancement and contrast-free MRI techniques. Awareness of the strengths and limitations of different approaches to obtain state of the art MR images of the breast will facilitate the work-up of patients with suspicious breast lesions.

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Section: Indications For Breast Mrimentioning

confidence: 99%

What’s Hot in Breast MRI

Scaranelo

2021

Can Assoc Radiol J

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“…Also, our limited sample failed to compare the different prognoses of patients with MRI positivity/pathological malignancy to those with MRI negativity. MRI has been playing an increasingly important role in identifying primary occult lesions and predicting therapeutic effects [29,30]. If an occult focus is found via MRI, it should be excluded from the occult neoplasm in this study.…”

Section: Discussionmentioning

confidence: 99%

Mastectomy and Breast Conserving Therapy Share Comparable Survival and Efficacy on Patients with Occult Breast Cancer: A Retrospective Study in China

Jia

Ren

et al. 2022

Preprint

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Purpose This single-center retrospective study aimed to compare the efficacy of mastectomy and Breast Conserving Therapy (BCT) on overall survival (OS) and disease-free survival (DFS) and examine prognostic factors of Occult Breast Cancer (OBC) in China. Methods We conducted a univariate Kaplan-Meier analysis and a multivariate Cox proportional hazards model on OBC patients in Cancer Hospital, Chinese Academy of Medical Science (CHCAMS), comparing prognostic factors including treatment plans, risk factors, TNM stages, metastasis, and recurrence. Results Seventy patients with OBC undergoing axillary lymph node dissection (ALND) were included with median follow-up of 84.0 months. No statistically significant differences in OS (HR, 1.64; 95% CI, 0.59-4.51; p=0.327) and DFS (HR, 1.83; 95% CI, 0.60-4.89; p=0.200) were observed between mastectomy (n=23) and BCT (n=37). Positive estrogen receptor and progesterone receptor suggested better survival in univariate analysis. Patients with more severe N stage presented inferior survival. The association between radiotherapy and worse survival was probably because patients with higher TNM stages tended to receive radiotherapy. Low Ki-67 level (≤14%) predicted worse outcomes in both univariate and multivariate analyses. Conclusion Mastectomy with ALND presented comparable prognosis outcomes to BCT with ALND for OBC patients.

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“…This study was based on data from an era predating routine use of breast MRI during preoperative assessment. Recent studies specifically evaluating MRI-negative OBC have also demonstrated no differences in survival outcomes between these therapeutic approaches [14]. Accordingly, the consensus of the MTB discussion after obtaining the additional genomic studies was that BCT with RT was sufficient for local management of the primary tumor and suspected second OBC.…”

Section: Molecular Tumor Boardmentioning

confidence: 99%

Histologic Discordance Between Primary Tumor and Nodal Metastasis in Breast Cancer: Solving a Clinical Conundrum in the Era of Genomics

et al. 2021

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Next-generation sequencing (NGS) technologies have become increasingly used for managing breast cancer. In addition to the conventional use of NGS for predicting recurrence risk and identifying potential actionable mutations, NGS can also serve as a powerful tool to understand clonal origin and evolution of tumor pairs and play a unique role in clarifying complex clinical presentations. We report an unusual case of early-stage breast cancer in which the primary tumor and draining axillary node were histologically discordant. The primary tumor was invasive lobular carcinoma, whereas the nodal metastasis was invasive ductal carcinoma. This discordance led us to question whether the tumors had the same origin. NGS performed on both specimens identified no overlapping variants, leading us to conclude that the patient had two separate primary breast cancers, with the nodal tumor representing metastasis from an occult breast cancer. DNA sequencing of the primary tumor and the nodal metastasis allowed us to predict the patient's recurrence risk, and we initiated adjuvant chemotherapy and hormonal therapy based on these results. This case illustrates the utility of NGS for successfully managing a rare and challenging case. The Oncologist 2021;26:1000-1005 KEY POINTS• A degree of molecular concordance is expected for tumors originating from a common stem or progenitor cell. Histological discordance and absence of any genomic overlap should raise suspicion for two separate primary tumors. • Paired DNA sequencing of the primary tumor and nodal metastasis can inform clinical decisions when primary breast tumor and axillary metastasis are histologically discordant. Molecular/Precision Oncology Tumor Board is the best setting to facilitate such decisions in these challenging cases. • Paired DNA sequencing under these rare circumstances may suggest an occult breast tumor.

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Outcome of breast-conserving treatment for axillary lymph node metastasis from occult breast cancer with negative breast MRI

Cited by 23 publications

References 34 publications

What’s Hot in Breast MRI

What’s Hot in Breast MRI

Mastectomy and Breast Conserving Therapy Share Comparable Survival and Efficacy on Patients with Occult Breast Cancer: A Retrospective Study in China

Histologic Discordance Between Primary Tumor and Nodal Metastasis in Breast Cancer: Solving a Clinical Conundrum in the Era of Genomics

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