I would like to consult you regarding a patient. A 42-year-old female patient at an outside center underwent an excisional biopsy(!) for a retroareolar lesion classified as BI-RADS 5. The pathology report indicates that all surgical margins are positive. The lesion is described as an 18x14mm invasive ductal carcinoma with ER 80+, PR 70+, and HER2 negative status.
The patient's MRI and ultrasound show thickened cortex lymph nodes, and the PET scan mentions level 1-2 lymph nodes. Should I proceed with the initial treatment plan, or should I complete the surgery?
According to Ki67 status, NAC is considered as the priority. Depending on the situation, breast and perhaps axillary suscept node clipping can be performed.
However, MG and MRI findings should be evaluated in detail by the breast radiologist in terms of additional focal and local invasion findings. There may be significant changes in the surgical approach based on these data.
Do you know the Ki-67 index and histogical grade of the tumor? I would like to know the axillary tumor burden. If Ki-67 is high and histological grade 3, I may consider neoadjuvant chemotherapy. If there are many lymph nodes involved, I would also start with neoadjuvant chemotherapy
This patient is a luminal a. We must do completion surgery. We must do axillary biopsy before surgery. We can do TAD if there are 1-3 positive lymph nodes. We Must do genetic test.