Surgical Management of the Axilla in Patients with Occult Breast Cancer (cT0 N+) After Neoadjuvant Chemotherapy

Cohen, Brianna L.; Collier, Amber L.; Kelly, Kristin N.; Goel, Neha; Kesmodel, Susan B.; Yakoub, Danny; Möller, Mecker G.; Avisar, Eli; Franceschi, Dido; Macedo, Francis I.

doi:10.1245/s10434-020-08227-w

Cited by 13 publications

(3 citation statements)

References 26 publications

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“…For N1 patients, SLNB combined with RT may be an alternative to ALND. Some research studies show that SLNB may be an option in selected patients with OBC who downstage following neochemotherapy (46). Our analysis found that, for patients with ALND only or ALND + BS, RT can significantly improve their OS.…”

Section: Discussionmentioning

confidence: 60%

Best treatment options for occult breast cancer: A meta-analysis

et al. 2023

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ObjectivesOccult breast cancer (OBC) is a rare malignant breast tumor. Because of the rare cases and limited clinical experience, a huge therapeutic difference has existed all over the world and standardized treatments have yet been established.MethodsA meta-analysis was conducted using MEDLINE and Embase databases to identify the choice of OBC surgical procedures in all studies: (1) patients undergoing axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) only; (2) patients undergoing ALND with radiotherapy (RT); (3) patients undergoing ALND with breast surgery (BS); (4) patients undergoing ALND with RT and BS; and (5) patients undergoing observation or RT only. The primary endpoints were mortality rates, the second endpoints were distant metastasis and locoregional recurrence.ResultsAmong the 3,476 patients, 493 (14.2%) undergo ALND or SLNB only; 632 (18.2%) undergo ALND with RT; 1483 (42.7%) undergo ALND with BS; 467 (13.4%) undergo ALND RT and BS, and 401 (11.5%) undergo observation or RT only. After comparing the multiple groups, both groups 1 and 3 have higher mortality rates than group 4 (30.7% vs. 18.6%, p < 0.0001; 25.1% vs. 18.6%, p = 0.007), and group 1 has higher mortality rates than groups 2 and 3 (30.7% vs.14.7%, p < 0.00001; 30.7 vs. 19.4%, p < 0.0001). Group (1 + 3) had a prognosis advantage over group 5 (21.4% vs. 31.0%, p < 0.00001). There was no significant difference both in the distant recurrence rates and locoregional rates between group (1 + 3) and group (2 + 4) (21.0% vs. 9.7%, p = 0.06; 12.3% vs. 6.5%, p = 0.26).ConclusionOn the basis of this meta-analysis, our study indicates that BS including modified radical mastectomy (MRM) and breast-conserving surgery (BCS) combined RT may appear as the optimal surgical approach in patients with OBC. RT cannot prolong both the time of distant metastasis and the local recurrences.

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Section: Discussionmentioning

confidence: 60%

Best treatment options for occult breast cancer: A meta-analysis

et al. 2023

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“…Due to the limitation of the number of cases, we did not compare the prognostic effects of difference treatments. In addition, due to the lack of detailed information on patient treatment, we did not include the treatment of lymph nodes in our analysis, which is an important local treatment for early-stage OBC and may provide benefits in combination with surgery or radiotherapy ( 15 , 18 , 28 ), and this may have also affected the results of our systemic treatment analysis.…”

Section: Discussionmentioning

confidence: 99%

Survival analysis and nomogram for early-stage occult breast cancer with positive lymph nodes based on the SEER database

Man¹,

Han²,

Wang³

et al. 2022

Ann Transl Med

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Background: Occult breast cancer (OBC) is a rare type of breast cancer, which accounts for 0.3-1.0% of all breast cancers. However, the treatment of OBC remains controversial, especially the local treatment. We aimed to analyze the impact of different treatment and N stage on survival in early-stage OBC patients, and construct a nomogram to predict the prognosis. Methods:The data of patients with early-stage breast cancer were obtained from 17 registries in the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics and breast cancerspecific survival (BCSS) were compared among the groups. Cox proportional risk models were used for both the univariate and multivariate analyses. Variables with a P value <0.07 in the univariate analysis were included in the multivariate analysis. The independent prognostic factors were included in the nomogram and validated internally.Results: A total of 492 early-stage OBC patients were randomized at a 7:3 ratio into the training cohort (n=348) and the testing cohort (n=144). N2+ stage patients had a worse prognosis than N1 stage patients (P=0.0051). Triple-negative breast cancer (TNBC) patients had the worst prognosis. Early-stage OBC patients benefited from surgery (P=0.0093) and radiotherapy (P=0.0102), but not chemotherapy (P=0.4030).An analysis of OBC patients with different N stages showed that in terms of treatment, N1 stage patients benefited from surgery (P=0.023), but did not benefit significantly from radiotherapy (P=0.0793), whereas N2+ stage patients benefited from radiotherapy (P=0.0098), but the benefit from surgery was not significant (P=0.1005). In the multivariate analysis, N stage, surgery, and radiotherapy remained statistically significant.Based on the results of the multivariate analysis, we constructed a nomogram for estimating the 3-and 5-year BCSS of OBC patients. The concordance index and the calibration plots show that our nomogram had sufficient accuracy and good coordination.Conclusions: N stage, surgery, and radiotherapy were identified as independent prognostic factors for OBC. We successfully constructed a nomogram using these independent risk factors and demonstrated that it could help predict the 3-and 5-year BCSS of OBC patients. Further data analyses need to be conducted to revise the treatment of early-stage OBC.

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“…Current recommendations for patients with OBC with negative MRI findings include axillary lymph node dissection (ALND) plus whole breast radiotherapy (RT) with or without nodal RT or ALND plus mastectomy with or without RT. 42 In cases of axillary metastasis in OBC, MRM may be necessary for the localization, excision, and biological characterization of the primary tumor. 43 Patients who did not undergo mastectomy were reported to have worse survival than those who did.…”

Section: Discussionmentioning

confidence: 99%

Occult Invasive Lobular Carcinoma Presenting as an Axillary Skin Metastatic Lesion Underwent Neoadjuvant Endocrine Therapy and Surgical Resection: A Case Report and Review of Literature

Busbait¹,

Alkhalifa²,

Aljohani³

et al. 2022

BCTT

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Introduction Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5–15% of all breast cancer cases. It usually presents with nonspecific signs and symptoms. Occult breast cancer presenting as an axillary mass is rare, with prevalence of 0.3–1%, less likely with isolated cutaneous breast metastasis as a first presentation. There are limited data in the literature on patients who underwent endocrine therapy and complete surgical resection. Case Presentation A 54-year-old woman with left axillary skin swelling that had been persisting for 6 years was diagnosed with ILC 18 months ago presenting with an ulcerated axillary skin lesion and was managed with letrozole in another facility as she was estrogen receptor (ER) and progesterone receptor (PR) positive. She received letrozole for 18 months and had a partial response in the form of healing of the ulcer with persistent subcutaneous nodules. Her breast mammogram, ultrasound, and magnetic resonance imaging findings were unremarkable; however, there were few prominent left axillary lymph nodes. A biopsy of the left axillary lymph node was positive for malignancy, consistent with ILC. A skin punch biopsy of the axillary skin lesion showed ILC extending to the dermis with no background breast tissue. The patient underwent left modified radical mastectomy with excision of the left axillary skin lesion. The breast specimen comprised 0.4 mm of ILC as the primary malignancy and nine positive axillary lymph node malignancies. The patient received adjuvant radiotherapy and continued to receive letrozole. There were no signs of complications or recurrence during the follow-up period. Conclusion Ulcerated skin lesions in the axilla should raise concerns regarding breast cancer metastasis. In cases of isolated cutaneous breast metastases, surgical excision can be considered in combination with endocrine therapy.

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Surgical Management of the Axilla in Patients with Occult Breast Cancer (cT0 N+) After Neoadjuvant Chemotherapy

Cited by 13 publications

References 26 publications

Best treatment options for occult breast cancer: A meta-analysis

Best treatment options for occult breast cancer: A meta-analysis

Survival analysis and nomogram for early-stage occult breast cancer with positive lymph nodes based on the SEER database

Occult Invasive Lobular Carcinoma Presenting as an Axillary Skin Metastatic Lesion Underwent Neoadjuvant Endocrine Therapy and Surgical Resection: A Case Report and Review of Literature

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