Chapter 11. Breast
A 65-year-old female presented with a 2.5-cm mass in her right breast that on core needle biopsy had high-grade DCIS. She is taken to the operating room for lumpectomy and SLN biopsy. The patient was injected with both blue dye and radiotracer, but no SLN could be identified. What will this patient’s treatment include?
B. Lumpectomy and radiation only
C. Mastectomy and axillary lymph node dissection only
D. Lumpectomy and radiation and axillary lymph node dissection
E. Mastectomy and axillary lymph node dissection and radiation
Answer: D. If no tracer or blue dye is taken up by the lymph nodes, a lymph node dissection must be performed along with breast-conserving therapy (i.e., lumpectomy) and radiation.
A premenopausal 42-year-old female has been diagnosed with ER+/PR+ invasive ductal carcinoma. Her lesion is 2 cm in size, and she has 2 positive lymph nodes. She had chosen to undergo breast-conserving therapy. What will her postsurgical treatment include?
B. Radiation therapy only
D. Radiation therapy and tamoxifen
E. Chemotherapy, radiation therapy, and tamoxifen
Answer: E. Since the patient has positive nodal status, chemotherapy is necessary. Also undergoing breast-conserving therapy, the patient must receive radiation. Since she is premenopausal and her nodal status is positive, tamoxifen would also be given.
A 62-year-old female presents with scaly skin surrounding her nipple that has not resolved. A biopsy including skin was performed at this area. Pathology returns with large vacuolated cells in the epithelium, and no other atypical cells or cancerous cells are present. Her treatment should be:
A. Modified radical mastectomy
D. Simple mastectomy with SLN
E. Wide excision of the skin involved
Answer: B. The patient has Paget disease that involves more than the nipple without evidence of malignancy; thus, the treatment is simple mastectomy.
A 36-year-old female who is 20 weeks’ pregnant presents with a palpable mass. Ultrasound-guided core needle biopsy reveals a 3-cm invasive ductal carcinoma. She wishes to undergo breast-conserving therapy. What treatment is indicated for her?