Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin

Abstract

The records of 42 patients who had axillary metastases compatible with a clinically occult breast primary were reviewed. Forty patients had mammography performed as part of their evaluations. Mastectomy yielded the primary tumor in one of 13 patients; biopsy yielded positive results in one of five. Among the 29 patients who did not undergo mastectomy, 16 received breast irradiation, and 13 were simply observed for signs of the primary tumor. For the patients who did not undergo mastectomy, the 5-year actuarial risk for appearance of a primary was 17% in the irradiated group versus 57% in the nonirradiated group (P = 0.06). Patterns of failure are correlated with stage and local and systemic therapy. The results affirm our belief that patients with axillary metastases histologically consistent with breast tumor should be treated identically to patients with similar nodal stages and proven breast primaries.

Axillary nodal metastases from carcinoma of unknown primary (CUPAx): a systematic review of published evidence

“…It should be reminded that seven of 10 CUPAx patients would be found to harbour a small breast primary on mastectomy. Moreover, in three series a trend for survival advantage in CUPAx patients receiving adjuvant therapy was suspected [17,18,28] despite frequent lack of adequate management of the breast/axilla fully eradicating gross disease. No series provide information on use of neoadjuvant chemotherapy in patients with CUPAx: most patients undergo axillary nodal clearance immediately after fine needle aspiration/ excisional biopsy or in the presence of unresectable lymph nodes, axillary irradiation.…”

“…Statistical significance of these survival differences was reached occasionally. In 1990 Ellerbroek et al [17] presented a series of 42 patients of whom 13 were treated with mastectomy, 16 with breast irradiation and 13 observed. They reported that breast cancer-free 5-year survival was 83% for patients who had their breasts conserved but treated with irradiation versus 43% for those who were managed with observation (P = 0.06).…”

“…Regarding clinicopathologic prognosticators nodal burden was recognized as the sole factor of prognostic significance [12,15,18,19,21,24], with patients with N1 disease (1-3 involved axillary lymph nodes) experiencing better locoregional disease control, fewer distant failures as well as superior overall survival when compared to patients with N2-3 disease. Other parameters with reported favourable prognostic or predictive significance were performance of axillary nodal dissection and absence of gross disease after surgery [17], local treatment of the ipsilateral breast by means of mastectomy or irradiation [23,24,26,28]. Data on outcome of patients with CUPAx are shown in Tables 5 and 6.…”

Treatable Subsets in Cancer of Unknown Primary Origin

“…Other treatment-responsive subgroups have been described with characteristic clinicopathological presentations, including women with adenocarcinoma involving axillary lymph nodes 16,17) and patients with squamous cell carcinoma involving cervical lymph nodes. 18) In this study, however, there was no patient belonging to either of these subgroups.…”

Cancer of Unknown Primary: Changing Approaches. A Multidisciplinary Case Presentation from the Joan Karnell Cancer Center of Pennsylvania Hospital

“…A breast cancer is usually presumed when a women presents with adenocarcinoma in the axillary nodes without an evident primary [39][40][41][42][43][44]. MRI has been particularly helpful when there is a high suspicion of a breast primary with a negative physical exam and mammogram [43,44].…”