What is your approach to initial management of patient with clinically palpable axillary disease, histologically proven breast cancer, with no imaging evidence of an occult primary or metastatic disease?

Would you proceed with modified radical mastectomy followed by systemic therapy, or would you consider neoadjuvant therapy? Would biomarker status matter? (such as utilizing Xeloda for residual disease following neoadjuvant therapy in triple-negative setting)

Answer from: Medical Oncologist at Academic Institution

The frequency of TXN+M0 cases has declined with the availability of breast MRI, as many cancers occult on mammography and ultrasound are detected by MRI, but they still occur, and are usually high grade, triple-negative or HER2+. I treat these as I would any patient with node-positive dis...

Answer from: Medical Oncologist at Community Practice

I had a similar case; no breast primary on mammo, breast us and mri. I ended up doing a PET-CT and found a small signal in the ipsilateral breast. We did a biopsy (w/marker placement) that identified the primary breast lesion (TNBC, IDC). Anyways, I am currently doing neoadjuvant chemo.

Comments

Medical Oncologist at Warren Alpert Medical School of Brown University
That's interesting - I have not used PET to look f...

Medical Oncologist at Ventura County Medical Center
Good observation; PET-CT was recommended in our tu...

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What is your approach to initial management of patient with clinically palpable axillary disease, histologically proven breast cancer, with no imaging evidence of an occult primary or metastatic disease?

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