The choice of therapeutic tactics in a patient with diagnosed breast cancer and lung neoplasm
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.518
Abstract
Breast cancer (BC) has long held a leading position in oncology disease pattern among global female population. Statistics data show that BC metastasis to lung tissue accounts for 21–32 % of all distant metastasis cases. Pulmonary metastases usually occur within 5 years after initial BC diagnosis, more often affecting peripheral lung parts, which explains the difficulty for their differential diagnosis. In addition, they profoundly impact on disease course and patient survival rate, so that each case of combined pathology such as BC and lung solid neoplasm is of interest in terms of clinicopathologic features as well as the diagnostic approach, with subsequent choice of surgical treatment tactics. Obviously, a therapeutic strategy in such cases is based on knowing primary tumor morphological structure and verifying metastatic process. However, in case of small sized pulmonary focus, it is difficult to identify a modality of ongoing process. Currently, no therapeutic and diagnostic tactics in such cases have been developed in detail. Assessing the clinical case of a combined ВС and a single small-sized focal lung mass, we propose an effective diagnostics and treatment scheme.
About the Authors
N. Yu. Germanovich
Vishnevsky National Medical Research Centre of Surgery, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Natalia Yu. Germanovich, MD, PhD
27 Bolshaya Serpukhovskaya Str., Moscow 115093
M. Yu. Pikunov
Vishnevsky National Medical Research Centre of Surgery, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Mikhail Yu. Pikunov, MD, PhD
27 Bolshaya Serpukhovskaya Str., Moscow 115093
T. A. Shchegolkova
Vishnevsky National Medical Research Centre of Surgery, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Tatyana A. Shchegolkova, MD
27 Bolshaya Serpukhovskaya Str., Moscow 115093
I. M. Mishchenko
Vishnevsky National Medical Research Centre of Surgery, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Inna M. Mishchenko, MD
27 Bolshaya Serpukhovskaya Str., Moscow 115093
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What is already known about this subject?
► Metastatic breast cancer (ВС) is a heterogeneous group of diseases with varying clinical manifestations. Both solitary (single or oligometastatic) as well as multiple, or diffuse, lesions are observed.
► In 3 % of ВС women radiologic findings include a solitary shadow in the lung recognized as a metastatic lesion. BC metastasis to the lung tissue comprises 21–32 % distant metastasis cases leading to fatal outcome in 60–70 % of cases.
► When the size of pulmonary node is less than 1 cm or its anatomic location is unfavorable for diagnostic testing, surgical intervention is required to confirm pathomorphologic diagnosis.
What are the new findings?
► The therapeutic and diagnostic algorithm for patients with diagnosed ВС and focal peripheral lung neoplasm is presented.
► The role of surgical intervention such as videothoracoscopic lung resection with urgent histologic examination for diagnosis verification and determining neoplasm morphologic composition was demonstrated.
► A two-stage surgical strategy was developed to exclude the secondary lung neoplasm with subsequent removal of the primary focus.
How might it impact on clinical practice in the foreseeable future?
► Application of the proposed therapeutic and diagnostic algorithm in clinical practice will optimize and improve the quality of treatment for patients with diagnosed ВС and focal peripheral lung neoplasm.
► The use of such surgical tactics will allow morphologic verification of single focal masses in the lungs with unfavorable anatomic location for diagnostic puncture.
► Exclusion of secondary lesions in patients with diagnosed ВС will avoid unnecessary cardio-, hepato- and nephrotoxic chemotherapy.
Review
For citations:
Germanovich N.Yu., Pikunov M.Yu., Shchegolkova T.A., Mishchenko I.M. The choice of therapeutic tactics in a patient with diagnosed breast cancer and lung neoplasm. Obstetrics, Gynecology and Reproduction. 2024;18(5):735–742. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2024.518
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