A 30-year-old woman at 10 weeks of gestation is diagnosed with a 1.8 cm ER-positive, HER2-negative invasive ductal carcinoma of the left breast with a clinically negative axilla. Which surgical approach is most appropriate?

• A Breast conservation surgery with sentinel node biopsy now, radiotherapy after delivery
• B Therapeutic abortion followed by standard breast conservation
• C Neoadjuvant chemotherapy followed by breast conservation at term
• D Modified radical mastectomy now, with deferred reconstruction ✓

Explanation

Breast conservation requires postoperative radiotherapy, which is contraindicated in the first trimester, so modified radical mastectomy is the appropriate choice for operable cancer diagnosed early in pregnancy; it avoids delaying definitive surgery until delivery. Sentinel node biopsy using technetium sulphur colloid is considered acceptable in pregnancy, but conservation cannot be completed safely at this gestation. Therapeutic abortion confers no oncological advantage and is not required for treatment.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.