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. 2024 Apr 16;16(8):1518.
doi: 10.3390/cancers16081518.

Ocular and Periocular Metastasis in Breast Cancer: Clinical Characteristics, Prognostic Factors and Treatment Outcome

Yacoub A Yousef  1 , Mona Mohammad  1 , Hanan Khalil  2 , Tala Khouri  1 , Rand Alsweiti  1 , Jakub Khzouz  3 , Dima Abu Laban  4 , Imad Jaradat  5 , Ahmad Kh Ibrahimi  5 , Akram Al-Ibraheem  6 , Mahmoud Al Masri  7 , Ibrahim AlNawiaseh  1 , Hikmat Abdel-Razeq  2   8
Affiliations

Ocular and Periocular Metastasis in Breast Cancer: Clinical Characteristics, Prognostic Factors and Treatment Outcome

Yacoub A Yousef et al. Cancers (Basel). .

Abstract

Background: Breast cancer remains a leading cause of cancer-related mortality and morbidity worldwide. Ocular and periocular metastasis present as a rare but clinically significant manifestation. This study aims to explore demographics and clinical aspects of ocular and periocular metastasis in breast cancer patients.

Methods: A retrospective cohort study comprising 45 breast cancer patients with ocular or periocular metastasis treated between 2013 and 2023. Patient demographics, tumor characteristics, diagnostic methods, treatment modalities, visual outcomes, and survival data were analyzed.

Results: Among 9902 breast cancer patients, 0.5% developed ocular or periocular metastasis, constituting 2.4% of metastatic cases. The median age was 50 years. Ocular metastasis timing varied: 5% before breast cancer, 24% concurrent, 22% within a year, and 49% after. The most common presentations included incidental MRI findings (42%) and vision decline (31%). Metastasis involved the orbit (47%), choroid (40%), optic nerve (11%), and iris (2%), with 44% having bilateral involvement. Predictive factors included invasive lobular carcinoma (ILC) (p < 0.0001) and brain metastasis (p < 0.0001), with ILC exhibiting a sixfold higher likelihood of ocular metastasis than invasive ductal carcinoma (IDC). Primary treatment was radiation therapy (89%), yielding a 55% maintenance of excellent vision (<0.5), with 93% developing dry eye disease. Patients with ocular metastasis faced an increased risk of disease-related mortality (p < 0.0001), with 71% succumbing within 10 months post-diagnosis.

Conclusions: Ocular metastasis in breast cancer is rare (0.5%) but signifies poor outcome. It is linked to ILC and concurrent brain metastasis. Primary treatment involves radiation therapy, with a favorable visual prognosis.

Keywords: breast cancer; choroidal metastasis; ocular metastasis; periocular metastasis; treatment outcomes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Orbit CT axial scan shows soft tissue mass with involvement of the right lateral rectus muscle and extension into the right periorbital space. This is associated with partial encasement and displacement of the right optic nerve and mild proptosis. (B) Muscle biopsy: H&E 20× higher magnification reveals metastatic lobular carcinoma of the breast infiltrating the skeletal muscles. Note the linear/single-cell file arrangement of tumor cells (Indian-file pattern). (C) GATA3 20× tumor cells show nuclear positivity for GATA3 immunostain, confirming breast origin.
Figure 2
Figure 2
A 43-year-old female with metastatic breast cancer to the optic nerves. Fundus photos for the right (A) and left (B) eyes show bilateral infiltrates around the optic nerves, more prominent in the right eye (A). Ocular B-scan photos show clearly the hyperechoic masses over the right (C) and left (D) optic nerves. Orbit MRI Axial T1-weighted scan with contrast (E) shows thickening of the optic nerve sheath that extends to the optic nerve head (more prominent on the right side), irregular outline, and stranding of surrounding fat planes. Fundus photos for the same patient 3 months post orbit EBRT: major regression in optic nerve infiltrates in both eyes: right (F); left (G).
Figure 3
Figure 3
Kaplan–Meier curve showing overall survival (in months) for 45 patients with breast cancer who developed ocular or periocular metastasis.
See this image and copyright information in PMC

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