title: Nonpalpable breast carcinomas: long-term evaluation of 1,258 cases.
abstract: BACKGROUND
  In recent decades, a steady improvement in imaging diagnostics has been observed together with a rising adherence to regular clinical breast examinations. As a result, the detection of small clinically occult (nonpalpable) lesions has progressively increased. At present in our institution some 20% of the cases are treated when nonpalpable. The aim of the present study is to analyze the characteristics and prognosis of such tumors treated in a single institution.
  
  
  METHODS
  The analysis focused on 1,258 women who presented at the European Institute of Oncology with a primary clinically occult carcinoma between 2000 and 2006. All patients underwent radioguided occult lesion localization (ROLL), axillary dissection when appropriate, whole breast radiotherapy, or partial breast intraoperative irradiation and received tailored adjuvant systemic treatment.
  
  
  RESULTS
  Median age was 56 years. Imaging showed a breast nodule in half of the cases and a breast nodule accompanied by microcalcifications in 9%. Microcalcifications alone were present in 17.1% of the cases, whereas suspicious opacity, distortion, or thickening represented the remaining 24.6%. Most tumors were characterized by low proliferative rates (68.9%), positive estrogen receptors (92.3%), and non-overexpressed Her2/neu (91.3%). After a median follow-up of 60 months, we observed 19 local events (1.5%), 12 regional events (1%), and 20 distant metastases (1.6%). Five-year overall survival was 98.6%.
  
  
  CONCLUSIONS
  Clinically occult (nonpalpable) carcinomas show very favorable prognostic features and high survival rates, showing the important role of modern imaging techniques.
authors.affiliation: IEO European Institute of Oncology, Milan, Italy. umberto.veronesi@ieo.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.forename: Stefano
authors.initials: S
authors.lastname: Zurrida
authors.forename: Simonetta
authors.initials: S
authors.lastname: Monti
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Enrico
authors.initials: E
authors.lastname: Cassano
authors.forename: Antuono
authors.initials: A
authors.lastname: Latronico
authors.forename: Maria
authors.initials: M
authors.lastname: Pizzamiglio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viale
authors.forename: Dario
authors.initials: D
authors.lastname: Vezzoli
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotmensz
authors.forename: Simona
authors.initials: S
authors.lastname: Musmeci
authors.forename: Fabio
authors.initials: F
authors.lastname: Bassi
authors.forename: Loredana
authors.initials: L
authors.lastname: Burgoa
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paganelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D002114:Calcinosis / Q000473:pathology; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation; D011379:Prognosis; D016217:Ultrasonography, Mammary