Margin is involved....small foci.....appropriate local radiotherapy might be enough

I think the same, unlike the medical oncologist of my hospital.

Thanks for your opinion.

I think radiotherapy is enough .

If patient is young chemotherapy should be added,combined therapy will be better for the patient.

For DCIS you can follow Van Nuys score... In your case info- "with single small foci, negative margin", is not sufficient... Pls also see margin distance/ Size and Histo and decide accordingly-

The Van Nuys Prognostic Index is based on lesion size, margin, tumor grade, presence of necrosis, and age and is used to determine greatest risk of recurrence. The low-scoring group may be treated with partial mastectomy alone. The intermediate-scoring group has been shown to benefit from adjuvant radiation therapy, and the high-scoring group should undergo mastectomy because the risk of recurrence with partial mastectomy with or without radiation is high.

Van Nuys Scoring System

Score

1 2 3

Size (mm) d15 >15–40 >40

Margins (mm) S10 1

Further step will depend on the age of the patient wheather old or young

Present guide line recomend 10 mm margin but using van Nuys scoring to guide intervention seems very adequate

then the margin is not free. What is the age?

47 years old, premenopausal.

agree with Rajeev Tewari, we need full histopathological examination, also ER, PR status...

And we need the margin involvement direction? medial, lateral, upper, lower, anterior or posterior involvement?

I think the better care for this patient (premenopausal) is mastectomy and RT.

dear collagues,

for deciding to make a re-excision or radiotherapy,we should take into attention following points:

1-van Nuys score

2-volume of the involved breast and any asymmetry between the other(if there is a macromasty,a bilateral reduction mammaplasty wil be the best solution)or other kind of oncoplastic procedures to provide symmetry

3-patients wish:a- no operation : try radiotherapy for local control(at least 85 percent for 10 years)

if she wants only a last operation,a nipple and skinsparing mastectomy+prosthesis instead of simple mastectomy(this preference should be supported by pathologic findings or a high van Nuys score

kind regards

Dr.Ragıp KAYAR (from TURKEY)

As because there is an isolated foci of intraductal carcinoma in the free margin so reexcision is one option. Age of the patient and receptor status is to be considered. If it is tripple negative then mastectomy is the another option. Otherwise Radiation therapy is the next option.

Dr. Anwar (From Bangladesh)

Only mastectomy - young woman