Management of New Breast Lesion in Patient with History of Breast Cancer

Staging and Diagnosis

The American College of Radiology recommends that a patient with ipsilateral recurrence or second primary triple-negative breast cancer (TNBC) in stage IA should undergo total mastectomy with complete axillary evaluation, followed by adjuvant chemotherapy, as the previous conservative surgery with radiotherapy has already been performed and ipsilateral recurrence in a previously irradiated breast has a worse prognosis than a new primary 1, 2, 3
The European Society for Medical Oncology suggests that before proceeding with any definitive local treatment, it is imperative to complete systemic staging, as locoregional recurrence is frequently associated with distant disease 4
A detailed physical examination with evaluation of all lymph node areas (axillary, supraclavicular, infraclavicular bilateral) is recommended 4, 1
Laboratory studies, including complete blood count, liver and renal function tests, alkaline phosphatase, and calcium, should be performed 4
Chest imaging, such as radiography or CT scan, should be done to rule out pulmonary metastases 4
Abdominal imaging, such as ultrasound, CT, or MRI, should be performed to identify visceral hepatic disease 4
Bone scintigraphy with confirmation of lesions by radiography/CT/MRI is recommended 4
PET/CT is particularly useful when traditional imaging methods are equivocal and can help confirm whether it is an isolated locoregional recurrence, as this subgroup of patients may benefit from a more aggressive multidisciplinary approach 4

The American College of Radiology recommends that mastectomy is the treatment of choice in this scenario due to the previous conservative surgery with radiotherapy and the high risk of local recurrence 1, 2, 3
Biopsy of the sentinel lymph node is recommended if the axilla is clinically negative and the axillary ultrasound is negative 1, 2
Complete axillary dissection is recommended if there are clinically positive lymph nodes or positive axillary biopsy 4

The European Society for Medical Oncology suggests that adjuvant chemotherapy is indicated in TNBC even in early stages due to the high risk of metastatic recurrence 5
Chemotherapy regimens based on anthracyclines and taxanes are the standard, such as paclitaxel 175 mg/m² every 3 weeks 5

The American College of Radiology recommends that follow-up should include annual diagnostic bilateral mammography, although mammography may be suboptimal for early detection of TNBC due to rapid growth and frequent benign characteristics 6
Ultrasound of the breast is superior to mammography for detection of TNBC 6
MRI of the breast is the most sensitive modality for detection of TNBC and should be considered in high-risk follow-up 6
Physical examination every 2-3 months during the first 2 years, then every 6 months is recommended 6