Occult breast cancer: a challenge from a surgical perspective

Patients with occult breast cancer pose a challenging diagnostic and therapeutic problem. High-quality mammography is required to decrease the false-negative rates. A number of other imaging methods have been proposed in the diagnostic evaluation of these women, including breast ultrasonography, color Doppler ultrasonography, breast magnetic resonance imaging (MRI), positron emission tomography (PET), and scintimammography. Among them, MRI may be particularly helpful, since it has a high sensitivity and may enable preoperative localization of the primary, thus allowing the surgeon to perform a breast conserving procedure. Treatment options include surgery, radiotherapy and watchful waiting (followed by mastectomy when a breast tumor is detected). Systemic therapy is usually required in the management of these patients.