Abstract
Introduction: Occult primary breast cancer, i.e., isolated axillary adenocarcinoma without detectable tumor in the breast by either physical exam or mammography, represents up to 1% of operable breast cancer. Modified radical mastectomy (MRM) is generally the accepted treatment for this condition although tumor is identified in only two-thirds of mastectomy specimens. Breast magnetic resonance imaging (MRI) can identify occult breast carcinoma and may direct therapy. This study examined the ability of breast MRI to detect occult breast cancer and to facilitate breast conservation therapy.
Methods: Forty women with biopsy-proven metastatic adenocarcinoma to an axillary lymph node and no evidence of primary cancer were studied. All patients had a physical examination, mammography, and MRI of the breast. Using a dedicated breast coil, MRI imaging was performed with and without gadolinium enhancement. Positive MRI scans were compared with histopathologic findings at the time of operation (n 5 21).
Results: MRI identified the primary breast lesion in 28 of 40 women (70%). Of these 28 patients, 11 had MRM, 11 had lumpectomy/axillary lymph node dissection (ALND)/radiotherapy (XRT), 2 had ALND/XRT alone, and 4 had no local treatment secondary to stage IV disease. Two women initially treated with lumpectomy/ALND subsequently had mastectomy for positive margins. Of the women with positive MRI who had breast surgery, 21 of 22 (95%) had tumor within the surgical specimen. Twelve women had negative MRI of the breast. Five of these 12 underwent MRM, of whom 4 had no tumor in the mastectomy specimen. The remaining 7 patients had ALND and whole breast radiation (ALND/XRT) (n 5 5), or were observed (n 5 2). Overall, 18 of 34 women surgically treated had MRM, while 16 (47%) preserved their breast. Tumor yield for patients having breast surgery was 81%.
Conclusions: MRI of the breast can identify occult breast cancer in many patients and may facilitate breast conservation in select women. Negative breast MRI predicts low tumor yield at mastectomy.
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References
Baron PL, Moore MP, Kinne DW, Candela FC, Osborne MP, Petrek JA. 1990; Occult breast cancer presenting with axillary metastases. Updated management. Arch Surg 125:210–14.
Copeland EM, McBride CM. 1973; Axillary metastases from unknown primary sites. Ann Surg 178:25–7.
Rosen PP. 1980; Axillary lymph node metastases in patients with occult noninvasive breast carcinoma. Cancer 46:1298–306.
Ashikari R, Rosen PP, Urban JA, Senoo T. 1976; Breast cancer presenting as an axillary mass. Ann Surg 183:415–7.
Rosen PP, Kimmel M. 1990; Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients. Hum Pathol 21:518–23.
Tench DW, Page DL. 1998 The unknown primary presenting with axillary lymphadenopathy. In Bland. KI, Copeland, EM, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. WB Saunders Co. Philadelphia, 1041–5.
Kemeny MM. 1992; Mastectomy: is it necessary for occult breast cancer? NY State J Med 92:516–7.
Vilcoq JR, Calle, R, Ferme, F, Veith, F. 1982; Conservative treatment of axillary adenopathy due to probable subclinical breast cancer. Arch Surgery 117:1136–8.
Ellerbroek N, Holmes F, Singletary E, Evans H, Oswald M, McNeese M. 1990; Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin. Cancer 66:1461–7.
Adler DD, Wahl RL. 1995; New methods for imaging the breast: techniques, findings, and potential. AJR 164:19–30.
Orel SG, Hochman MG, Schnall MD, Reynolds C, Sullivan DC. 1996; High-resolution MR imaging of the breast: clinical context. Radiographics 16:1385–401.
Harms, SE, Flamig, DP. 1993; MR imaging of the breast. J Magn Reson Imaging 3:277–83.
Heywang SH, Wolf A, Pruss E, Hilbertz T, Eiermann W, Permanetter W. 1989; MR imaging of the breast with Gd-DTPA: use and limitations. Radiology 171:95–103.
Hulka CA, Smith BL, Sgroi DC, et al. 1995; Benign and malignant breast lesions: differentiation with echo-planar MR imaging. Radiology 197:33–8.
Morris EA, Schwartz LH, Dershaw DD, Van Zee, KJ, Abramson AF, Liberman L. 1997; MR imaging of the breast in patients with occult primary breast carcinoma. Radiology 205:437–40.
Tilanus-Linthorst MM, Obdeijn AI, Bontenbal M, Oudkerk M. 1997; MRI in patients with axillary metastases of occult breast carcinoma. Breast Cancer Res Treat 44:179–82.
Kemeny MM, Rivera DE, Terz JJ, Benfield JR. 1986; Occult primary adenocarcinoma with axillary metastases. Am J Surg 152: 43–7.
Orel SG, Schnall MD, Newman RW, Powell CM, Torosian MH, Rosato EF. 1994; MR imaging-guided localization and biopsy of breast lesions: initial experience. Radiology 193:97–102.
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Olson, J.A., Morris, E.A., Zee, K.J.V. et al. Magnetic Resonance Imaging Facilitates Breast Conservation for Occult Breast Cancer. Ann Surg Oncol 7, 411–415 (2000). https://doi.org/10.1007/s10434-000-0411-4
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DOI: https://doi.org/10.1007/s10434-000-0411-4