ubmslateCN-logo-ubm

CN Mobile Logo

Search form

Topics:

Synchronous Bilateral Breast Cancer With Discordant Histology

Synchronous Bilateral Breast Cancer With Discordant Histology

Oncology (Williston Park). 31(4):274–277,312.
Figure 1. Right Breast Cancer
Figure 2. PET/CT Scan
Figure 3. Left Breast Cancer

The Case

A 48-year-old Caucasian woman presented with a palpable right breast mass. Physical examination confirmed a lump on the upper outer quadrant of her right breast. Mammogram showed bilateral dense breasts with abnormal microcalcifications. Ultrasound of the right breast revealed a 3.6-cm hypoechoic area, along with some abnormal-appearing axillary lymph nodes. Ultrasound-guided biopsy of the right breast lesion and one of the axillary lymph nodes showed an invasive ductal carcinoma, negative for estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2)/neu receptors (Figure 1). Staging workup with positron emission tomography (PET)/CT confirmed the right breast lesion, with a maximum standardized uptake value (SUV) of 12, and multiple loci of right axillary nodal involvement, with an SUV of 4. There was no other uptake in the rest of the PET/CT scan; however, there was an incidental finding of increased metabolic activity in the left lateral breast, with an SUV of 4.7 (Figure 2). Further ultrasound examination of this area revealed some indeterminate hypoechoic abnormal-appearing tissue, approximately 3 cm in diameter. Ultrasound-guided needle biopsy of this area showed invasive lobular carcinoma, positive for estrogen receptor (99% of nuclei) and progesterone receptor (35% of nuclei); the HER2/neu immunohistochemistry score was 1+ (Figure 3). The patient’s mother had been diagnosed with breast cancer at the age of 65 years, and with colon cancer at age 70. Her family history was negative for Ashkenazi Jewish ancestry. Genetic testing for mutations in the BRCA1 and BRCA2 genes was negative.

Which of the following treatment plans has the least support from the available evidence?

A. Neoadjuvant chemotherapy followed by bilateral surgery (mastectomy or lumpectomy) with sentinel lymph node (SLN) evaluation on the left side, with or without completion axillary dissection even if SLN is positive; completion axillary dissection on the right side, followed by adjuvant chemotherapy, hormonal therapy, and unilateral or bilateral radiation therapy, depending on the surgical pathology results

B. SLN evaluation on the left side prior to neoadjuvant chemotherapy, with neoadjuvant chemotherapy followed by bilateral surgery (mastectomy or lumpectomy) with or without completion axillary dissection even if SLN is positive; completion axillary dissection on the right side, followed by adjuvant chemotherapy, hormonal therapy, and unilateral or bilateral radiation therapy, depending on the surgical pathology results

C. Bilateral surgery (mastectomy or lumpectomy) with SLN evaluation on the left side, with or without completion left axillary dissection even if SLN is positive; completion axillary dissection on the right side, followed by adjuvant chemotherapy, hormonal therapy, and unilateral or bilateral radiation therapy, depending on the surgical pathology results

D. Neoadjuvant concurrent chemotherapy and hormonal therapy, followed by bilateral surgery (mastectomy or lumpectomy) with SLN on the left side, with or without left axillary dissection even if SLN is positive; completion axillary dissection on the right side, followed by adjuvant chemotherapy, hormonal therapy, and unilateral or bilateral radiation therapy, depending on the surgical pathology results

Pages

By clicking Accept, you agree to become a member of the UBM Medica Community.