Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ann Surg Oncol. 2013 Oct;20(10):3308-16. doi: 10.1245/s10434-013-3157-5. Epub 2013 Aug 22.
Management of occult primary breast cancer (OPBC), including the role of magnetic resonance imaging (MRI), is controversial. We conducted a pooled analysis of OPBC patients and a meta-analysis of MRI accuracy in OPBC in order to elucidate current practices.
A literature search yielded 201 studies. Patient-level data for clinically/mammographically OPBC from studies published after 1993 and from our institution were pooled; logistic regression examined associations between patient/study data and outcomes, including treatments and recurrence. We report adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI) significant at 2-tailed p < 0.05. Meta-analysis included data for patients who received MRIs for workup of clinically/mammographically OPBC. We report pooled sensitivity and specificity with 95 % CIs.
The pooled analysis included 92 patients (15 studies [n = 85] plus our institution [n = 7]). Patients from Asia were more likely to receive breast surgery (OR = 5.98, 95 % CI = 2.02-17.65) but not chemotherapy (OR = 0.32, 95 % CI = 0.13-0.82); patients from the United States were more likely to receive chemotherapy (OR = 13.08, 95 % CI = 2.64-64.78). Patients from studies published after 2003 were more likely to receive radiotherapy (OR = 3.86, 95 % CI = 1.41-10.55). Chemotherapy recipients were more likely to have distant recurrence (OR = 9.77, 95 % CI = 1.10-87.21). More patients with positive MRIs received chemotherapy than patients with negative MRIs (10 of 12 [83.3 %] vs 5 of 13 [38.5 %]; p = 0.0414). In the MRI-accuracy meta-analysis (10 studies, n = 262), pooled sensitivity and specificity were 96 % (95 % CI = 91-98 %) and 63 % (95 % CI = 42-81 %), respectively.
OPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards.
隐匿性原发性乳腺癌（OPBC）的管理，包括磁共振成像（MRI）的作用，存在争议。我们对 OPBC 患者进行了汇总分析，并对 OPBC 中 MRI 准确性进行了荟萃分析，以阐明当前的实践情况。
文献检索得到 201 项研究。对 1993 年后发表的研究和我们机构的临床/乳房 X 线摄影 OPBC 患者的患者水平数据进行了汇总；逻辑回归分析了患者/研究数据与治疗和复发等结局之间的关联。我们报告了调整后的优势比（OR）和 95%置信区间（95%CI），双侧 p<0.05 为有统计学意义。荟萃分析包括了因临床/乳房 X 线摄影 OPBC 接受 MRI 检查的患者的数据。我们报告了汇总的敏感性和特异性，以及 95%CI。
汇总分析纳入了 92 名患者（15 项研究[ n=85]加我们机构[ n=7]）。来自亚洲的患者更有可能接受乳房手术（OR=5.98，95%CI=2.02-17.65），但不太可能接受化疗（OR=0.32，95%CI=0.13-0.82）；来自美国的患者更有可能接受化疗（OR=13.08，95%CI=2.64-64.78）。来自 2003 年后发表的研究的患者更有可能接受放疗（OR=3.86，95%CI=1.41-10.55）。接受化疗的患者更有可能发生远处复发（OR=9.77，95%CI=1.10-87.21）。更多的 MRI 阳性患者接受了化疗，而 MRI 阴性患者接受化疗的比例较低（12 例中的 10 例[83.3%]与 13 例中的 5 例[38.5%]；p=0.0414）。在 MRI 准确性荟萃分析中（10 项研究，n=262），汇总的敏感性和特异性分别为 96%（95%CI=91-98%）和 63%（95%CI=42-81%）。
OPBC 的管理在地理和时间上存在差异。我们建议建立一个国际 OPBC 患者登记处，以促进纵向研究并制定全球治疗标准。
