Occult breast cancer presenting with axillary metastases. Updated management
P. L. Baron, M. P. Moore, D. W. Kinne, F. C. Candela, M. P. Osborne and J. A. Petrek
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
An isolated axillary lymph node metastasis in a woman without an obvious
clinical primary site most frequently originates from the breast.
Mastectomy has been the historical treatment of choice. A retrospective
study of 35 patients was undertaken to evaluate the roles of modern
mammography, breast preservation, and adjuvant systemic therapy in the
management of these patients. Twenty-eight patients underwent a mastectomy,
while 7 were managed by a combination of limited resection and/or axillary
dissection and radiation therapy. Twenty-two (67%) of the 33 breast
specimens contained carcinoma. Comparison of the pathologic results with
the preoperative mammograms showed a specificity of 73%, while the
sensitivity was only 29%. Actuarial 5-year survival after mastectomy or
breast preservation was similar (77% and 65%, respectively). Patients with
more than one positive lymph node benefited from adjuvant therapy.
Mammography does not locate the majority of occult stage II breast cancers,
and both breast preservation and adjuvant therapy may have roles in the
management of these patients.
Utility of Breast Magnetic Resonance Imaging in Patients With Occult Primary Breast Cancer
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Cancer of Unknown Primary Origin
Briasoulis and Pavlidis
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