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Occult Breast Cancer Presenting With Axillary Metastases: Updated Management

Occult Breast Cancer Presenting With Axillary Metastases: Updated Management Abstract • 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. (Arch Surg. 1990;125:210-215) References 1. Halsted WS. The results of radical operations for the cure of carcinoma of the breast . Ann Surg . 1907;46:1-19.Crossref 2. Ashikari R, Rosen PP, Urban JA, Senoo T. Breast cancer presenting as an axillary mass . Ann Surg . 1976;183:415-417.Crossref 3. Fitts WT, Steiner GC, Enterline HT. Prognosis of occult carcinoma of the breast . Am J Surg . 1963;106:460-463.Crossref 4. Owen HW, Dockerty MB, Gray HK. Occult carcinoma of the breast . Surg Gynecol Obstet . 1954;98:302-308. 5. Westbrook KC, Gallager HS. Breast cancer presenting as an axillary mass . Am J Surg . 1971;122:607-611.Crossref 6. Patel J, Nemoto T, Rosner D, Dao TL, Pickren JW. Axillary lymph node metastasis from an occult breast cancer . Cancer . 1981;47:2923-2927.Crossref 7. McLeod MK. Dilemmas in breast cancer: occult carcinoma and Paget's disease of the breast . In: Harness JK, Oberman HA, Lichter AS, et al, eds. Breast Cancer: Collaborative Management . Chelsea, Mich: Lewis Publishers Inc; 1988:211-232. 8. Patterson WB. Occult primary tumor with axillary metastases . In: Harris JR, Hellman S, Henderson IC, Kinne DW, eds. Breast Diseases . Philadelphia, Pa: JB Lippincott; 1987:608-613. 9. Copeland EM, McBride CM. Axillary metastases from unknown primary sites . Ann Surg . 1973;178:25-27. 10. Kemeny MM, Rivera DE, Terz JJ, Benfield JR. Occult primary adenocarcinoma with axillary metastases . Am J Surg . 1986;152:43-47.Crossref 11. Grundfest S, Steiger E, Sebek B. Metastatic axillary adenopathy: use of estrogen receptor protein as an aid in diagnosis . Arch Surg . 1978;113:1108-1109.Crossref 12. Iglehart JD, Ferguson BJ, Shingleton WW, et al. An ultrastructural analysis of breast carcinoma presenting as isolated axillary adenopathy . Ann Surg . 1982;196:8-13.Crossref 13. Bhatia SK, Saclarides TJ, Witt TR, Benomi PD, Anderson KM, Economou SG. Hormone receptor studies in axillary metastases from occult breast cancers . Cancer . 1987;59:1170-1172.Crossref 14. Clark GM, Osborne CK, McGuire WL. Correlations between estrogen receptor, progesterone receptor, and patient characteristics in human breast cancer . J Clin Oncol . 1984;2:1102-1109. 15. Haupt HM, Rosen PP, Kinne DW. Breast carcinoma presenting with axillary lymph node metastases . Am J Surg Pathol . 1985;9:165-175.Crossref 16. Kinne DW, Petrek JA, Osborne MP, Fracchia AA, Depalo AA, Rosen PP. Breast carcinoma in situ . Arch Surg . 1989;124:33-36.Crossref 17. Rosen PP, Braun DW, Kinne DW. The clinical significance of preinvasive breast carcinoma . Cancer . 1980;46:919-925.Crossref 18. Schwartz GF, Patchefsky AS, Finkelstein SD, et al. Nonpalpable in situ ductal carcinoma . Arch Surg . 1989;124:29-32.Crossref 19. Rosen PP. Axillary lymph node metastases in patients with occult noninvasive breast carcinoma . Cancer . 1980;46:1298-1306.Crossref 20. Ozzello L, Sanpitak P. Epithelial-stromal junction of intraductal carcinoma of the breast . Cancer . 1970;26:1186-1198.Crossref 21. Lagios MD, Margolin FR, Westdahl PR, Rose MR. Mammographically detected duct carcinoma in situ . Cancer . 1989;63:618-624.Crossref 22. Vilcoq JR, Calle R, Ferme F, Veithe F. Conservative treatment of axillary adenopathy due to probable subclinical breast cancer . Arch Surg . 1982;117:1136-1138.Crossref 23. Baum M, Brinkly DM, Dossett JA, et al. Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer . Lancet . 1985;1:836-840. 24. Glick JH, Abeloff MD, Brown BW, et al. Adjuvant chemotherapy for breast cancer . JAMA . 1985;254:3461-3463.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Occult Breast Cancer Presenting With Axillary Metastases: Updated Management

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1990.01410140088014
Publisher site
See Article on Publisher Site

Abstract

Abstract • 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. (Arch Surg. 1990;125:210-215) References 1. Halsted WS. The results of radical operations for the cure of carcinoma of the breast . Ann Surg . 1907;46:1-19.Crossref 2. Ashikari R, Rosen PP, Urban JA, Senoo T. Breast cancer presenting as an axillary mass . Ann Surg . 1976;183:415-417.Crossref 3. Fitts WT, Steiner GC, Enterline HT. Prognosis of occult carcinoma of the breast . Am J Surg . 1963;106:460-463.Crossref 4. Owen HW, Dockerty MB, Gray HK. Occult carcinoma of the breast . Surg Gynecol Obstet . 1954;98:302-308. 5. Westbrook KC, Gallager HS. Breast cancer presenting as an axillary mass . Am J Surg . 1971;122:607-611.Crossref 6. Patel J, Nemoto T, Rosner D, Dao TL, Pickren JW. Axillary lymph node metastasis from an occult breast cancer . Cancer . 1981;47:2923-2927.Crossref 7. McLeod MK. Dilemmas in breast cancer: occult carcinoma and Paget's disease of the breast . In: Harness JK, Oberman HA, Lichter AS, et al, eds. Breast Cancer: Collaborative Management . Chelsea, Mich: Lewis Publishers Inc; 1988:211-232. 8. Patterson WB. Occult primary tumor with axillary metastases . In: Harris JR, Hellman S, Henderson IC, Kinne DW, eds. Breast Diseases . Philadelphia, Pa: JB Lippincott; 1987:608-613. 9. Copeland EM, McBride CM. Axillary metastases from unknown primary sites . Ann Surg . 1973;178:25-27. 10. Kemeny MM, Rivera DE, Terz JJ, Benfield JR. Occult primary adenocarcinoma with axillary metastases . Am J Surg . 1986;152:43-47.Crossref 11. Grundfest S, Steiger E, Sebek B. Metastatic axillary adenopathy: use of estrogen receptor protein as an aid in diagnosis . Arch Surg . 1978;113:1108-1109.Crossref 12. Iglehart JD, Ferguson BJ, Shingleton WW, et al. An ultrastructural analysis of breast carcinoma presenting as isolated axillary adenopathy . Ann Surg . 1982;196:8-13.Crossref 13. Bhatia SK, Saclarides TJ, Witt TR, Benomi PD, Anderson KM, Economou SG. Hormone receptor studies in axillary metastases from occult breast cancers . Cancer . 1987;59:1170-1172.Crossref 14. Clark GM, Osborne CK, McGuire WL. Correlations between estrogen receptor, progesterone receptor, and patient characteristics in human breast cancer . J Clin Oncol . 1984;2:1102-1109. 15. Haupt HM, Rosen PP, Kinne DW. Breast carcinoma presenting with axillary lymph node metastases . Am J Surg Pathol . 1985;9:165-175.Crossref 16. Kinne DW, Petrek JA, Osborne MP, Fracchia AA, Depalo AA, Rosen PP. Breast carcinoma in situ . Arch Surg . 1989;124:33-36.Crossref 17. Rosen PP, Braun DW, Kinne DW. The clinical significance of preinvasive breast carcinoma . Cancer . 1980;46:919-925.Crossref 18. Schwartz GF, Patchefsky AS, Finkelstein SD, et al. Nonpalpable in situ ductal carcinoma . Arch Surg . 1989;124:29-32.Crossref 19. Rosen PP. Axillary lymph node metastases in patients with occult noninvasive breast carcinoma . Cancer . 1980;46:1298-1306.Crossref 20. Ozzello L, Sanpitak P. Epithelial-stromal junction of intraductal carcinoma of the breast . Cancer . 1970;26:1186-1198.Crossref 21. Lagios MD, Margolin FR, Westdahl PR, Rose MR. Mammographically detected duct carcinoma in situ . Cancer . 1989;63:618-624.Crossref 22. Vilcoq JR, Calle R, Ferme F, Veithe F. Conservative treatment of axillary adenopathy due to probable subclinical breast cancer . Arch Surg . 1982;117:1136-1138.Crossref 23. Baum M, Brinkly DM, Dossett JA, et al. Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer . Lancet . 1985;1:836-840. 24. Glick JH, Abeloff MD, Brown BW, et al. Adjuvant chemotherapy for breast cancer . JAMA . 1985;254:3461-3463.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1990

References

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