Question 1

Question

A 58-year-old woman underwent mastectomy for multicentric DCIS. Final pathology shows high-grade DCIS with comedonecrosis, margins negative by 3 mm, no invasion identified in 40 tissue blocks examined. Sentinel lymph node biopsy shows isolated tumor cells (0.1 mm cluster) positive for cytokeratin. The medical oncologist requests input on systemic therapy. Evaluate the significance of the nodal finding and recommendations.

Accepted Answer

Consider isolated tumor cells clinically insignificant, node-negative staging, endocrine therapy only if ER-positive

Answer

Upstage to invasive cancer, recommend chemotherapy and endocrine therapy

Answer

Perform completion axillary dissection to assess additional nodal involvement

Answer

Recommend axillary radiation and systemic chemotherapy

Answer

Repeat pathology review to identify occult invasion

Breast Surgery — MCQs

Breast Surgery — MCQs

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