How do you address the axilla in an incidentally found T1bNx invasive breast cancer with extensive DCIS on bilateral prophylactic mastectomy in BRCA-2 mutated woman?

Topics: Breast Cancer • Radiation Oncology

The patient is in her 40s with a BRCA-2 mutation and underwent bilateral prophylactic nipple-sparing, skin-sparing mastectomy. No sentinel nodes were taken. What (if anything) should be done to address the right axilla?

Answer from: Radiation Oncologist at Academic Institution

I would send her for an axillary ultrasound and biopsy any suspicious lymph nodes. Following a mastectomy, it is challenging to do a sentinel lymph node biopsy so surgical evaluation of the axilla usually requires an ALND. If by imaging the axilla is negative, I would run her tumor characteristics t...

Comments

Radiation Oncologist at AV Strauss MD
If there was no microvascular/lymphatic invasion, ...

Radiation Oncologist at Veterans Administration Hospital, Jackson,MS
I recommend using chemo if the nodes are positive.

Answer from: Radiation Oncologist at Community Practice

If systemic treatment, would change because of nodal status, would favor an attempt to SNLN or ALND. If no change, then would favor no additional treatment to axilla.

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