Habibollah,

I would refer to thoracic surgery for video assisted thoracoscopy for the purpose of diagnostic tissue sampling.

Regards,

Christopher

Dear Dr Christopher

we did it and nodules were not on the lung surfaces and because of size and location of noodle ,biopsy is not possible

Triple negative breast cancer is sensitive to chemotherapy. Start anthracycline based chemotherapy line and re-evaluate these subcentemetric lung nodules. The patient might be lucky enough to have these nodules disappear. If that's the case, then continue business as usual according to the guidelines and consider the chemotherapy as neoadjuvant.

Two years ago, I had a renal cell carcinoma patient who had subcentemetric lung nodules. He benefited from percutaneous radiofrquancy ablation after nephrectomy. Now he is doing well and these nodules still have same dimensions and he didn't need to start Sunitinib. These nodules were confirmed by biopsy to be fibrous tissue rather than previously known metastatic. 

Hi doctor mahmoodzadeh

If biopsy of lung nodoules isn't possible  the chemotherapy should be started; but before the chemotherapy, if avalable radioactive iodine scan is recommended.

Thanks Dr Mirzania

Your intention is curative?

Start chemotherapy immediately and worry about nodules later if they cannot be biopsied. AC-T protocol is preferable.  I wonder if tumour markers such as CA 15.3, CEA may be helpful as well as thyroglobulin level for possibility of thyroid carcinoma.

Would you consider doing PET CT. SUV of lung nodules..

Gene profiling,  

no

Breast cancer has known to employ a metabolic strategy that prefers fatty acids. Reducing fat in the diet may limit substrate for tumorigenesis and may be a viable strategy to improve to cytotoxicity of standard chemo/radiation. The tumor will utilize the pentose phosphate pathway to generate anti-oxidant activity which can limit cytotoxicit, a very low-carbohydrate diet may help.