5.2.3 Case Study
Name：Zhao××Gender：Female Age：60 years Ethnicity：Han Nationality Marriage：Married
Chief complaint：18 days after 2 cycles of chemotherapy for right breast cancer.
Current medical history：The patient was admitted to the hospital on 2019-06-04 for“self-testing right breast mass for 3 days”.There are surgical indications for improving the relevant examinations，and there are no contraindications.On 2019-06-12 under general anesthesia，operate“right breast cancer radical surgery（right breast cancer breast conserving surgery+sentinel node biopsy+lymphangiography）.”Postoperative diagnosis of pathological report on June 14，2019：right breast mass（B201906111）：tumor diameter about 2cm.malignant tumor，immunohistochemistry：ER（-），PR（-），Cerb-B2（1+），Ki-67（+，about 60%）combined with HE and immunohistochemistry，supports invasive cancer，and tends to invasive ductal carcinoma grade Ⅱ-Ⅲ.BRCA1/2 was not mutated.No lesions were seen under the upper and lower margins and under the basal microscope；no cancer metastasis was found in the right axillary sentinel lymph nodes（0/3）.There are indications for postoperative chemotherapy，2019-06-22 to the“TC”program chemotherapy，the chemotherapy process is smooth，and the blood picture is no special after the hospital.Today，we will come to our hospital for further treatment.The outpatient clinic will receive the“right breast cancer postoperative chemotherapy”.Since the onset，the patient's mental state is good，physical condition good，appetite normal，sleep good，weight unchanged，stool normal，and urine normal.
Past history：Denying hepatitis，tuberculosis，history of infectious diseases，history of cardiovascular disease，history of birth surgery，trauma，denying the history of blood transfusion，denying the history of food and drug allergy，and the history of vaccination is unknown.
Personal history：Born in the original place，living in Kunming City，Yunnan Province for a long time，no epidemic area，epidemic situation，history of contact with water，no smoking，drinking history.
Marriage and childbirth history：Married at the age of 25，the physical condition of the spouse：healthy，bred 2 children.Pregnancy 3，births 2，fetuses 2.
Menstrual history：13 years old，4-7/28，no menstrual age，menopause date：2009.Menstrual cycle rules，medium menstrual volume，normal color.No blood clots，no pain.
Family history：parents are deceased，brothers and sisters are alive，denying family history of infectious diseases，hereditary history，and history of cancer.
Physical examination
Body temperature：36.0℃Pulse：80 beats/min Breath：18 beats/min Blood pressure：120/80mmHg.(https://www.daowen.com)
Height：170cm Weight：60kg Body surface area：1.6924m2 KPS score：100 points.
Specialist examination
Double breast asymmetry，right breast loss showing postoperative changes，right breast skin had 15cm postoperative scar，prognosis can be，no redness，no skin induration，left breast is not clear abnormal，left axilla and supraclavicular enlargement Lymph nodes.
Auxiliary inspection
Preoperative ultrasound：A lump image can be seen at 8 o'clock in the lower right quadrant of the right breast.The size is about 21×15mm，6mm from the skin，20mm from the nipple，the shape is irregular，the boundary is unclear，Color Doppler shows：the inside of the mass and a rich blood flow signal can be seen.The right axilla can be seen with 1-2 abnormal parenchymal echoes of different sizes，most of which are about 20×7 mm.The shape is elliptical and the boundary is clear.Color Doppler shows that there are a few punctate blood flow signals in the abnormal parenchyma.
Substantial mass lesions in the right breast，the nature needs to be investigated，BI-RADS：4B，does not exclude breast Ca，recommended for ultrasound imaging and disease examination.Abnormal parenchymal echo of the right axilla，nature to be investigated，consider lymphadenopathy（proliferative？）.
Left breast and axillary lymph nodes：no obvious abnormalities.Postoperative diagnosis of pathological report on June 14，2019：right breast mass（B201906111）：tumor diameter about 2cm，malignant tumor，immunohistochemistry：ER（-），PR（-），Cerb-B2（1+），Ki-67（+，about 60%），BRCA1/2 was not mutated.In combination with HE and immunohistochemistry，it supports invasive carcinoma and tends to invasive ductal carcinoma grade Ⅱ-Ⅲ.No lesions were seen under the upper and lower margins and under the basal microscope；no cancer metastasis was found in the right axillary sentinel lymph nodes（0/3）.
Diagnosis：right lower breast quadrant invasive ductal carcinoma pT1NOMO，post-chemotherapy after stage IA，triple-negative
Treatment：This patient was the right external inferior quadrant invasive ductal carcinoma pT-1N0M0，after IA stage chemotherapy，triple-negative，low-risk type，postoperative chemotherapy regimen chose TC chemotherapy for 6 cycles，docetaxel 75 mg/m2，cyclophosphamide 600 mg/m2，the specific drug is TXT：130mg，CTX：0.9g，21 days a cycle.