Cancer Genetics and Epigenetics 2017, Vol.5, No.3, 11-16
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2.2.4 Radioisotope occult lesion localization (location ROLL)
Compared with other localization techniques, the positive rate and pathological positive rate of margin cancer
cells in OBC after local excision were greatly reduced. Therefore, radionuclide localization also reduces the
possibility of the second operations, better to consider the patient's appearance, and more humanized (Zand and
Assarian, 2016).
2.2.5 Digital breast tomosynthesis (DBT)
It has already become a accurate and reliable method to detect those highly suspected breast cancer but
mammography and ultrasound localization can not directly see the changes in the structure, the positive predictive
value of DBT guided biopsy was up to 47% (Freer et al., 2015).
3 Histology and Immunohistochemical Examination
3.1 Pathology
There is no difference between the occult breast cancer and the normal breast cancer, but the clinical pathology is
mainly consist of ductal carcinoma with low differentiation, and the malignant degree of the tumor cells is high,
showing diffuse infiltration of lymph nodes. Metastatic lesions were solid tumor cancer characteristics, may come
from the breast, showed low differentiation may come from malignant melanoma, serous or mucinous papillary
carcinoma may be from primary ovarian cancer, and high columnar cells secreting mucus gland cancer may come
from stomach, colon and lung (Shao, 2013).
3.2 Immunohistochemical detection
3.2.1 Estrogen Receptor (ER)
It was said that 50% ER in patients with occult breast cancer is positive, but ER negative and can not exclude
OBC. The sensitivity of ER expression in the diagnosis of breast cancer was 0.63 and the specificity was 0.95.
The positive rate of ER in occult breast cancer was lower than that in non occult breast cancer (Sun et al., 2014).
3.2.2 Progesterone Receptor (PR)
The positive rate of PR in occult breast cancer is lower than that in ER, and the expression of PR is less. The
survival rate of patients with PR (+) is higher than that of patients with PR (-), and the recurrence rate is lower
(Wang et al., 2013).
3.2.3 Gross Cystic Disease Fluid Protein-15 (GCDFP-15)
As a marker of plasma secretion, GCDFP-15 has a sensitivity and specificity of 0.98 and 0.62, respectively.
GCDFP-15 suggests that the risk of axillary lymph nodes is high in the breast, but about 5% of non breast cancers
can also be detected in GCDFP-15.
3.2.4 Breast globin
Axillary lymph node metastasis detected breast globin, the tumor is likely to come from the breast, its sensitivity
and specificity are 0.84 and 0.85, respectively.
4 Differential Diagnosis
Axillary lymph node metastasis should be differentiated from gastric cancer, colorectal cancer, pancreatic cancer,
lung cancer, lymphoma, accessory breast cancer, thyroid cancer, ovarian cancer, renal cell carcinoma, malignant
melanoma and soft tissue sarcoma.
5 Diagnosis
Generally, patients of occult breast cancer can not touch breast lumps, but they can touch axillary lymph nodes
with or without other parts of the lymph nodes, with a hard texture, no obvious tenderness, and adhesion with
surrounding tissues. The pathological and immunohistochemical examination of the axillary lymph nodes is
helpful for the diagnosis of OBC and exclude other diseases that metastasis to the axillary lymph nodes of the
axillary lymph nodes.
