Optimal Surgical Management for Occult Breast Carcinoma: A Meta-analysis

Occult breast cancer (OBC) represents a rare clinical entity and poses a therapeutic dilemma. Due to limited experience, no optimal treatment approaches have yet been established. A meta-analysis was performed using MEDLINE and EMBASE databases to identify all studies investigating the surgical options for OBC: (1) axillary lymph node dissection (ALND) with radiotherapy (XRT); (2) ALND with mastectomy; and (3) ALND alone. Comparative studies including nonoperative management (observation or XRT alone) were excluded. The primary endpoints were locoregional recurrence, distant metastasis, and mortality rates. The literature search yielded 42 publications. Seven studies met the inclusion criteria comprising 241 patients. Among these patients, 94 (39 %) underwent ALND with XRT, 112 (46.5 %) underwent mastectomy, and 35 (14.5 %) underwent ALND alone. Mean follow-up was 61.8 +/- A 16.2 months (range 5-396 months). Locoregional recurrence (12.7 vs. 9.8 %), distant metastasis (7.2 vs. 12.7 %), and mortality rates (9.5 vs. 17.9 %) were similar between ALND with XRT and mastectomy. ALND with XRT was superior to ALND alone regarding locoregional recurrence (12.7 vs. 34.3 %, p < 0.01) and there was a trend toward improved mortality rates (9.5 vs. 31.4 %, p = 0.09). There was no difference in survival outcomes between mastectomy and ALND with XRT of patients with OBC. Radiotherapy improves locoregional recurrence and, possibly mortality rates of patients undergoing ALND. Based on this meta-analysis, combined ALND and radiation therapy may appear as the optimal surgical approach in these patients.