1. 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

5. RIGHT 9 O’CLOCK PALPABLE RIGHT LEVEL 1 AXILLA ABNORMAL LN

6. Imaging Results Right breast 9 o’clock –Irregular mass –Maximum dimension 52 mm Right axilla –Multiple abnormal lymph nodes

7. RIGHT 9 O’CLOCK US BIOPSY RIGHT 9 O’CLOCK US BIOPSY MARKER CLIP RIGHT AXILLARY LN US BIOPSY

8. 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

9. BASELINE MRI

10. RIGHT 9 O’CLOCK KNOWN IDC RIGHT LEVEL 1 AXILLA KNOWN METASTATIC LAN LEFT 3 O’CLOCK NMLE 23 MM MRI BX = DCIS

11. Staging Studies CT C/A/P: no distant metastases Bone scan: no distant metastases

12. Treatment Options Surgery? Radiation Oncology? Medical Oncology?

13. 2/09 Clinical MRI3/09 MRI after 1 week sunitinib 6/09 MRI after 12 weeks sunitinib/paclitaxel 10/09 MRI after 15 weeks doxorubicin/cyclophosphamide

28. Thank you!