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Metastatic Breast Cancer
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SHAQUL QAMAR WANI
May 17, 2017
Yes sentinel node sampling should have been done in this patient,that would have been helpful for further management, but now the second issue is focal positivity of margin which can be taken care of. Either redo surgery with lymph node sampling or if patient refuses for so can be dealt with radiation to breast and with at least level I,and ii lymph node coverage, as her ki67 is also high,needs to be dealt with some adjuvant treatment in addition of harmony therapy.
Syed Sameer Nasir
May 18, 2017
Thanks for your input. I agree, this patient should have had sentinel lymph node biopsy with known invasive disease on core biopsy. This patient was referred to us after surgery and we discussed local and systemic therapy with her. She was clinically axillary LN negative (on physical exam and ultrasound). Margins were positive for microscopic focus of LCIS but not invasive cancer. Plan adjuvant radiation therapy. She is a candidate for adjuvant endocrine therapy and checking oncotype DX to decide on chemotherapy.
Vijay Devanhalli
May 19, 2017
I prefer to do a simple mastectomy + SLNB if core biopsy show as DCIS or LCIS as it reduces the chances of margin positivity, stages the disease accurately and obviates the need for postoperative RT.
HAMDI Djelloul
May 26, 2017
I agree; reexision for positive margins, or ,if refused,RT, then endocrine therapy regardless on oncotype DX score to discuss Chemo ( CMF or TC) if required
Apr 20, 2024
Pending Moderator approval.
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Sameer
Nasir
MD
SHAQUL QAMAR WANI
May 17, 2017
Syed Sameer Nasir
May 18, 2017
Vijay Devanhalli
May 19, 2017
HAMDI Djelloul
May 26, 2017
Apr 20, 2024
Pending Moderator approval.