Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Surg Res. 2013 Dec;185(2):684-9. doi: 10.1016/j.jss.2013.06.020. Epub 2013 Jul 2.
Management of occult primary breast cancer (OPBC), that is, breast cancer that first presents through regional nodal or distant disease without clinical or mammographic evidence of disease in the breast, has been controversial and inconsistent. Here, we review OPBC patients treated at our institution.
We conducted a retrospective review of women diagnosed with a first primary breast cancer between March 1999 and September 2010 to identify patients who presented with isolated axillary lymphadenopathy proven to be histologically consistent with primary breast malignancy but had no evidence of a breast mass on physical examination, mammography, or ultrasound. Descriptions of treatments received, recurrence, morbidity, and mortality as of October 2012 are reported.
Of 5533 patients reviewed, seven (0.1%) patients were identified. The median age was 65 y old (range, 40-72), and the median length of follow-up was 86 mo (range, 42-124). Four patients underwent modified radical mastectomy, one patient had a lumpectomy and axillary lymph node dissection, and two patients had axillary lymph node dissection without breast surgery. Four patients received adjuvant radiation therapy. All seven patients received chemotherapy. Three patients received endocrine therapy, and two patients received anti-HER2 therapy. At the last follow-up, all seven patients were alive with no evidence of disease.
Although there was some variation in the management of OPBC at our institution, our patients had excellent outcomes after multimodal treatment. Our results support a curative intent approach to the treatment of OPBC and illustrate the need for individualized treatment algorithms based on tumor biology and extent of the disease at diagnosis.
隐匿性原发性乳腺癌（OPBC）的治疗一直存在争议且不一致，即首先表现为区域淋巴结或远处转移而无乳腺临床或 X 线表现的乳腺癌。在此，我们回顾了在本机构治疗的 OPBC 患者。
我们对 1999 年 3 月至 2010 年 9 月期间诊断为首次原发性乳腺癌的女性进行了回顾性研究，以确定那些表现为孤立性腋窝淋巴结病且组织学上与原发性乳腺癌一致但体格检查、乳房 X 线照相或超声均未发现乳房肿块的患者。截至 2012 年 10 月，报告了接受的治疗、复发、发病率和死亡率的描述。
在回顾的 5533 例患者中，发现了 7 例（0.1%）患者。中位年龄为 65 岁（范围，40-72 岁），中位随访时间为 86 个月（范围，42-124 个月）。4 例患者接受了改良根治性乳房切除术，1 例患者接受了乳房肿块切除术和腋窝淋巴结清扫术，2 例患者仅接受了腋窝淋巴结清扫术而未行乳房手术。4 例患者接受了辅助放疗。所有 7 例患者均接受了化疗。3 例患者接受了内分泌治疗，2 例患者接受了抗 HER2 治疗。最后一次随访时，所有 7 例患者均存活且无疾病证据。
尽管我们机构在 OPBC 的治疗方面存在一些差异，但我们的患者在接受多模式治疗后取得了良好的结果。我们的结果支持对 OPBC 采用治愈性治疗方法，并说明需要根据肿瘤生物学和诊断时疾病的范围制定个体化的治疗方案。
