Case

• 48 y.o. healthy woman

• Right breast mass present for 4 weeks

• No other known health problems

• Clinical breast examination:– Fullness visible in R breast w/o skin changes– 3.5cm palpable mass R upper outer quadrant– Palpable R axillary lymph node

RIGHT 9 O’CLOCK PALPABLE

RIGHT LEVEL 1 AXILLA ABNORMAL LN

Imaging Results

• Right breast 9 o’clock– Irregular mass– Maximum dimension 52 mm

• Right axilla– Multiple abnormal lymph nodes

RIGHT 9 O’CLOCK US BIOPSY

RIGHT 9 O’CLOCK US BIOPSY MARKER CLIP

RIGHT AXILLARY LN US BIOPSY

Histopathology Results

• Right breast 9 o’clock– IDC – Nottingham II/III– ER+/PR+, Her2 neg by FISH– Ki67 50%

• Right axilla– LN with metastatic IDC

BASELINE MRI

RIGHT 9 O’CLOCK KNOWN IDC RIGHT LEVEL 1 AXILLA KNOWN METASTATIC LAN

LEFT 3 O’CLOCK NMLE 23 MM MRI BX = DCIS

Staging Studies

• CT C/A/P: no distant metastases

• Bone scan: no distant metastases

Treatment Options

• Surgery?

• Radiation Oncology?

• Medical Oncology?

2/09 Clinical MRI 3/09 MRI after 1 week sunitinib

6/09 MRI after 12 weeks sunitinib/paclitaxel

10/09 MRI after 15 weeks doxorubicin/cyclophosphamide

Thank you!