To describe diagnostic work-up in women with axillary nodal metastases from carcinoma of unknown primary (CUPAx) in the Breast Unit of our Hospital. To discuss the correct diagnostic management of patient with CUPAx (Fig.1). To review the literature and to analyze the breast MR performance in detecting primary occult breast cancer.

All breast MR examinations performed in the Breast Centre of Brotzu Hospital (Cagliari, Italy) between September 2015 and September 2018 were identified from the Radiology Database. All cases performing breast MR for CUPAx were recruited and clinical-diagnostic history was made from hospital imaging and clinical database. We received approval for this study from the chief of our Department. Ethical approval for the study, according to the National Research Ethics Service guidelines, was not required since it was performed retrospectively on data and images obtained during...

From 1225 breast MR examinations performed in the study period (3 years from September 2015 to September 2018), 21 women with axillary nodal metastases from carcinoma and occult breast cancer were identified. All these women underwent breast conventional imaging (mammography and ultrasonography) resulting negatives and lymph nodes biopsy diagnosing axillary nodal metastases from carcinoma. Mean age of patients was 57,7 (range: 33-71). Most of the patients came to our attention for the presence of an axillary mass. Only two patients had symptoms related to the...

In the case of histological diagnosis of axillary lymph node metastasis from adenocarcinoma or undifferentiated carcinoma it is very likely that the tumor origin from the breast. CUPAx represents 0.3-0.5% of all malignant neoplasms of the breast. It affects women with a mean age of 52.4 years who present with axillary adenopathy. The first step in the management of occult breast cancer is the histological diagnosis of the metastatic lesion which in the case of CUPAx is represented by axillary lymph nodes. The pathologist must...

Krämer A, Hübner G, Schneeweiss A, Folprecht G, Neben K. Carcinoma of Unknown Primary - an Orphan Disease? Breast Care (Basel), 2008;3:164-170 Pavlidis N et al. Diagnostic and therapeutic management of cancer of unknown primary. European Journal of Cancer 2003, 39:1990-2005 Pavlidis N et al. Cancer of unknown orimary site. Lancet 2012, 379:1428-35 Pentheroudakis G, Lazaridis G, Pavlidis N. Axillary nodal metastases from carcinoma of unknown primary (CUPAx): a systematic review of published evidence. Breast Cancer Res Treat, 2010;119:1-11 Taylor MB, Bromham NR, Arnold SE....