¿Es la disección axilar dirigida una alternativa en el carcinoma oculto de mama? Descripción de un caso

Abstract

Occult breast carcinoma is a very rare entity that is defined as the presence of axillary disease without detectable tumor in the breast. When searching for the origin of a tumor, the use of bimodal techniques such as PET/CT has become especially useful, but there is little evidence about the management of these tumors. Currently, the standard treatment is primary systemic therapy (PST), followed by axillary lymphadenectomy and radiotherapy of the breast and lymph node chains. In this case we present the possibility of treating this disease with a more conservative surgical approach: through directed axillary dissection in a patient with occult breast carcinoma, who debuted with the appearance of a single axillary adenopathy observed on tomography. After completing primary systemic therapy, a complete radiological response was confirmed and a directed axillary dissection was indicated, with evidence in the operating room of a coincidence between the sentinel lymph node and the lymph node initially biopsied. After completing the treatment with radiotherapy of the breast and lymph node chains and anti-Her2 therapy, the patient is disease-free. It seems that an axillary treatment similar to that of locally advanced breast cancer can be considered, so in limited axillary disease (N1) targeted axillary dissection associated with radiotherapy could be an alternative.