Optimizing the Treatment of Higher-Risk Early HER2-Positive Breast Cancer: Case Studies for Surgeons
CASE 2: PATIENT HISTORY AND PRESENTATION
Emilie is a 58-year-old factory worker with a husband and 1 daughter. She is active and healthy with no major medical issues. Routine screening mammogram found a 2.5-cm mass in the right lower quadrant of her right breast, confirmed by ultrasound. Biopsy results and initial work-up are summarized in Table 4.
Table 4. Summary of Emilie’s Work-Up, Including Pathology
Demographics
58 years old, femaleHeight: 5’7’’; Weight: 130 lb; BMI: 20.4
Personal Medical History
Major surgeries: C-section at birth of her daughterFirst menses at age 11 yearsDid not breastfeedNon-smoker; no alcoholFamily history of melanoma (paternal grandfather)No family history of breast or ovarian cancer
Clinical Exam
Palpable breast mass in lower right quadrant of right breastNo palpable lymph nodesPS 0Metabolic panel and CBC normal
Breast imaging
Initial screening mammogram shows a 2.5-cm density; breast composition is fatty (BI-RADS® category A)Lesion confirmed on breast ultrasound: 2.5 cmAxillary ultrasound : No suspicious nodes
Biopsy and pathologic evaluation
Ultrasound-guided core needle biopsy of breast lesion confirmed Grade 3 invasive ductal carcinomaER weakly positive (15%), PgR negative, HER2 IHC 3+
Emilie desires BCS and neoadjuvant therapy is recommended by the multidisciplinary team.
Based on current guidelines, what type of axillary surgery would you recommend?
what is the best time for surgery post new adjavant new therapy ?