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Geographic and Temporal Trends in the Management of Occult Primary Breast Cancer: A Systematic Review and Meta-Analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

OPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards.

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Acknowledgment

Dr. Fayanju was supported by the NIH Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant 5T32CA009621-22. Ms. Stoll and Dr. Colditz were supported by the Foundation for Barnes-Jewish Hospital. Dr. Jeffe was supported in part by the NCI Cancer Center Support Grant (P30 CA091842) to the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri. Portions of this study’s findings were presented at the American Society of Breast Surgeons 14th Annual Meeting, May 1–5, 2013.

Conflict of interest

None of the authors has any financial interests or conflicts to disclose.

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Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Oluwadamilola M. Fayanju MD, MPHS & Julie A. Margenthaler MD

  2. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Carolyn R. T. Stoll MPH, MSW & Graham A. Colditz MD, DrPH

  3. Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA

    Susan Fowler MLIS

  4. The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA

    Graham A. Colditz MD, DrPH, Donna B. Jeffe PhD & Julie A. Margenthaler MD

  5. Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Donna B. Jeffe PhD

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  1. Oluwadamilola M. Fayanju MD, MPHS
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  2. Carolyn R. T. Stoll MPH, MSW
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Correspondence to Oluwadamilola M. Fayanju MD, MPHS.

Appendix: PubMed Database Search Strategy for Meta-Analysis of Occult Primary Breast Cancer and MRI Accuracy

Appendix: PubMed Database Search Strategy for Meta-Analysis of Occult Primary Breast Cancer and MRI Accuracy

“Neoplasms, Unknown Primary”[Mesh] OR “occult primary cancer” OR “occult cancers” OR “occult primary cancers” OR “Occult Primary Neoplasms” OR “Occult Primary Neoplasm” OR “Unknown Primary Neoplasms” OR “Unknown Primary Neoplasm” OR “Unknown Primary Tumors” OR “Unknown Primary Tumor” OR “occult cancer” OR “occult carcinoma”) AND (“Breast Neoplasms”[Mesh] OR “Breast Neoplasm” OR “Breast Tumors” OR “Breast Tumor” OR “Mammary Carcinomas” OR “Mammary Carcinoma” OR “Mammary Neoplasm” OR “Mammary Neoplasms” OR “Breast Cancer” OR “Cancer of the Breast” OR “Cancer of Breast” OR “mamma cancer” OR “mammary cancer” OR “mammary gland cancer” OR “Mammary Ductal Carcinomas” OR “Mammary Ductal Carcinoma”) AND (“Axilla”[Mesh] OR axilla OR axillas OR underarm) NOT ((“Animals”[Mesh]) NOT (“Animals”[Mesh] AND “Humans”[Mesh]).

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Fayanju, O.M., Stoll, C.R.T., Fowler, S. et al. Geographic and Temporal Trends in the Management of Occult Primary Breast Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 20, 3308–3316 (2013). https://doi.org/10.1245/s10434-013-3157-5

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