Expert: Claes-Gustaf Nordquist, M.D. - 8/12/2009

Question
Worried about my mom-please help- 71 yr old-routine mammo jan 2009-negative-r breast very painful after mammo-c/o intense burning sensation-july 30,09 u/s=1.5 x .8 x 1.2cm 10'clock r breast-hypoechoic area-birads 5.  aug 6-u/s guid.needle biop=idc moderate.differentiated,grade 2, er+score 190, pr+score 220- all cores (3) involved by idc showing moderate tublule formation-severe nuclear anaplasia,low mitotic rate-grade 2 on nottingham.intermixed high grade duct carinom. in situ with comedonecrosis,invasion of adjacent fat.one microscopic focus very suspicious for lymphatic invasion.Immunostaining with markers for estrogen and progesterone receptors showes strong diffuse staining for both markers in malig.cells.met with general surgeon yesterday to discuss lumpect. vs mastec.- scheduled for mri both breasts in 5 days. should i ask for a pet scan? She had "bronchitis" last month-coughing alot-but it cleared up after antibiotics,prednisone and albuterol.- should i ask for sentinal node biop. or will he automatically do that with the lumpectomy?Thank you very much for your help-I'm very scared and confused right now.

Answer
Well I think a lumpectomy with sentinel lymph node biopsy and followed by radiation therapy and hormonal therapy will be good enough and giving her a minimum of problems. If there is any cancer in her node biopsy chemotherapy should also be added. Discuss all these points with her surgeon. A PET scan can be added to her MRI scans too as can a CT scan of her lungs. Good luck!