Background and Aims Occult breast cancer (OBC) is a rare type of breast cancer with low incidence and difficulty in identifying the primary breast lesion, leading to a vague definition and diagnosis for healthcare professionals. Additionally, due to the lack of large-scale clinical studies on the management strategies for OBC, the local and systemic treatment options, as well as prognosis information, pose considerable challenges for clinicians. This study was performed to attempt to provide clinical references by analyzing the clinical and pathological characteristics of 12 cases of OBC, summarizing the diagnostic and therapeutic process, and discussing the diagnostic and treatment strategies for OBC based on domestic and international literature.Methods A retrospective analysis was conducted on 12 cases of OBC patients treated in the Department of Breast Surgery at the First Affiliated Hospital of Xi'an Jiaotong University from May 2013 to April 2020. The clinicopathologic characteristics, MRI findings, treatment strategies, efficacy of neoadjuvant chemotherapy, and prognosis of these patients were analyzed.Results Of the 12 patients, the median age was 53 years, histological subtypes consisted of poorly differentiated adenocarcinoma, infiltrating ductal carcinoma, and carcinoma simplex, accounting for 66.7%, 25.0%, and 8.3% respectively. The molecular subtypes were luminal B type, HER-2 positive type, and triple-negative type, with proportions of 41.7%, 8.3%, and 50.0% respectively. According to the AJCC staging, 25.0% were stage Ⅱ, 58.3% were stage Ⅲ, and 16.7% were stage Ⅳ. MRI findings indicated unilateral axillary lymph node enlargement in 9 cases (75.0%), with 3 cases on the right side and 6 cases on the left side. Bilateral axillary lymph node enlargement was found in 1 case (8.3%). MRI revealed axillary lymph node enlargement and supraclavicular lymph node enlargement on the right side in 2 cases (16.7%). No suspicious malignant lesions were detected in the breast region on MRI in any of the patients. Among the 10 patients with non-stage Ⅳ OBC, 8 underwent modified radical mastectomy, 2 underwent axillary lymph node dissection only, and 2 patients diagnosed with stage Ⅳ at initial presentation did not undergo surgery. Three patients received neoadjuvant chemotherapy, and two of them achieved pathological complete response (pCR). The median follow-up time was (43±14) months. As of July 2022, six patients experienced recurrence and metastasis, with three deaths attributed to visceral metastasis.Conclusion Breast MRI examination has important value in the exclusionary diagnosis of OBC. The treatment strategy for OBC can involve neoadjuvant therapy, modified radical mastectomy, axillary lymph node dissection based on molecular subtypes and lymph node staging. Postoperative adjuvant radiotherapy, chemotherapy, and endocrine therapy may be considered as adjunctive treatments.