Occult Breast Cancer Presenting with Axillary Lymph Node Metastasis: A Clinicopathological Analysis and Survival Outcomes

Öz

Abstract Aim: Occult breast cancer (OBC) is a rare clinical entity characterized by axillary lymph node metastasis without a detectable primary tumor in the breast. This study aimed to evaluate the clinicopathological features and the impact of different treatment modalities on survival in patients diagnosed with OBC. Methods: A total of 14 patients diagnosed with OBC between 2016 and 2024 were retrospectively analyzed. Diagnosis was confirmed clinically and through multimodal imaging, including ultrasonography, mammography, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET-CT). Demographic data, immunohistochemical profiles, surgical interventions, systemic therapies, and survival rates were evaluated. Results: The cohort was predominantly female (92.9%), with a mean age of 54.6 years. The most common presenting symptom was a palpable axillary mass (71.4%). Molecular subtypes were identified as Luminal A (50%), Luminal B (35.7%), and Triple-Negative (14.3%). The 5-year survival rate was 100% in patients who underwent either modified radical mastectomy (MRM) or breast-conserving surgery (BCS) combined with axillary lymph node dissection (ALND). In contrast, the survival rate was 50% for those who underwent ALND alone and 0% for those who received no surgical intervention (p=0.003). While radiotherapy was associated with a higher 5-year survival rate compared to no radiotherapy (90.9% vs. 50%), this difference was not statistically significant (p=0.083). No significant associations were found between survival and age, smoking status, neoadjuvant chemotherapy, or endocrine therapy (p>0.05). Conclusions: Multimodal treatment is essential for OBC. Breast-directed surgery combined with axillary dissection significantly improves survival compared to either axillary dissection alone or no surgical intervention. Keywords: Axillary lymph node metastases; occult breast carcinoma; radiotherapy; surgery; survival

Anahtar Kelimeler

• Axillary lymph node metastases
• occult breast carcinoma
• radiotherapy
• surgery
• survival

Aksiller Lenf Noduna Metastaz ile Prezente Olan Okült Meme Kanseri: Klinikopatolojik Analiz ve Sağkalım Sonuçları

Öz

Özet Amaç: Okült meme kanseri (OMK), memede saptanabilir bir primer tümör olmaksızın aksiller lenf nodu metastazı ile karakterize nadir bir klinik antitedir. Bu çalışmanın amacı, OMK tanısı alan hastalarda klinikopatolojik özellikleri ve farklı tedavi modalitelerinin sağkalım üzerindeki etkisini değerlendirmektir. Materyal ve Metot: 2016-2024 yılları arasında OMK tanısı alan toplam 14 hasta retrospektif olarak analiz edildi. Tanı; klinik muayene ve ultrasonografi, mamografi, manyetik rezonans görüntüleme (MRG) ve pozitron emisyon tomografisi/bilgisayarlı tomografi (PET-BT) dahil olmak üzere multimodal görüntüleme yöntemleri ile konfirme edildi. Demografik veriler, immünohistokimyasal profiller, cerrahi girişimler, sistemik tedaviler ve sağkalım oranları değerlendirildi. Bulgular: Kohortun büyük çoğunluğu kadın (%92,9) olup ortalama yaş 54,6 olarak saptandı. En sık başvuru semptomu palpabl aksiller kitle (%71,4) idi. Moleküler alt tipler Luminal A (%50), Luminal B (%35,7) ve Triple-Negatif (%14,3) olarak tanımlandı. Modifiye radikal mastektomi (MRM) veya meme koruyucu cerrahi (MKC) ile birlikte aksiller lenf nodu diseksiyonu (ALND) uygulanan hastalarda 5 yıllık sağkalım oranı %100 olarak bulundu. Buna karşın, sadece ALND uygulananlarda sağkalım oranı %50, cerrahi girişim uygulanmayanlarda ise %0 olarak saptandı (p=0,003). Radyoterapi alan hastalarda 5 yıllık sağkalım oranı, almayanlara göre daha yüksek olmasına rağmen (%90,9'a karşı %50), bu fark istatistiksel olarak anlamlı bulunmadı (p=0,083). Sağkalım ile yaş, sigara kullanımı, neoadjuvan kemoterapi veya endokrin tedavi arasında anlamlı bir ilişki saptanmadı (p>0,05). Sonuç: OMK yönetiminde multimodal tedavi esastır. Aksiller diseksiyon ile kombine edilen meme odaklı cerrahi, tek başına aksiller diseksiyona ya da cerrahi yapılmamasına kıyasla sağkalımı anlamlı derecede iyileştirmektedir. Anahtar Kelimeler: Aksiller lenf nodu metastazları; okült meme karsinomu; radyoterapi; cerrahi; sağkalım

Anahtar Kelimeler

• aksiller lenf nodu metastazları
• okült meme kanseri
• radyoterapi
• cerrahi
• sağkalım

Kaynakça

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