Reviewer’s report
Title: 
Axillary metastasis from occult breast cancer and synchronous
contralateral breast cancer initially suspected to be cancer with contralateral
axillary metastasis: A case report
Version: 
1 
Date: 
23 Sep 2021
Reviewer's report:
It is a very rare case that occult breast cancer and contralateral breast cancer
developed at the same time. And how to make a diagnosis (whether to judge her
as stage 
Ⅳ
 or bilateral simultaneous breast cancer) is important. Development of
techniques such as MRI and PET-CT, I think such troublesome cases will
increase recently. I consider it is possible to find out if they are really the same
origin or not by performing a gene search, but I don't think it is so necessary in
terms of cost effectiveness.
In this case as well, the final judgment was left early breast cancer and right
occult breast cancer, but I feel that the evidence is scarce. (Considering short
follow-up period and both are ER-positive breast, there are some suspicious that
the left breast cancer has metastasized to the contralateral axillary lymph node by
throwing the parathoracic lymph node and lymph flow.)
Of course, cooperation with the radiology department and the pathology
department is important, and I think that it is a perfect medical treatment process,
but I don't feels there is any message for the both treatment and diagnostic
methods.
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