53yr old lady was diagnosed with bilateral breast disease elsewhere...T2N2M0 lesion right breast with multiple small BIRADS IVb lesions left breast (largest 1 x1cm) on Sonomammo..Right breast lump biopsy revealed IDC grade II, Er/PR +ve, Her 2 Neu -ve, and blind biopsy of left largest lesion revealed DCIS...PET CT had picked up only right breast lump and no uptake in left..she underwent upfront MRM with LD flap reconstruction for right breast lesion in Nov 2017...HPE revealed T3aN2a IDC grade II NOS type, LVI +be, 10/14 nodes+ve (including 2apical nodes)..she received 4#AC --->12#Pacli --->RT to chest wall with boost (Sept 2018)...follow up scan in Dec2018 picked up a lesion at the site of previous largest lesion in left breast and no other lesion ...Stereotactic biopsy revealed IDC grade I...lumpectomy was done which revealed 2.2x2 cm IDC grade II, Strong bER/PR +ve, Her2Neu -ve..Fresh MRI breast reveals no lesion
Dilemmas in treatment:
Whether to do Mastectomy left side as to begin with it was a multicentric disease confirmed by other lesions disappearing after chemo?
Whether to do left axillary dissection straight away as technically post chemo so no role of SLNB
Whether to wait and watch as currently no proof of disease in left breast.
Whether to wait and watch even for the left axillary and cover axilla with RT as anyhow she has to receive RT for left BCS
What about Chemotherapy
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