How do you approach a post-menopausal female with early stage ER+,HER2+ breast cancer s/p lumpectomy with invasive ductal histology and lymph node involvement with invasive lobular histology?   

The discrepancy between histology in the lymph node and breast is concerning for occult invasive lobular carcinoma in the breast. It would be a good idea to obtain second opinion in pathology.  If pathology is confirmed, breast MRI could help identify invasive lobular cancer that may not be eas...

Given invasive lobular histology in the axillary lymph node, strong consideration should be given to MRI Breast to look for Invasive lobular primary lesion. The mammographic sensitivity for detecting invasive lobular carcinoma is in range of 30-80 % , compared to the reported sensitivity of MRI...

Adjuvant Chemotherapy and Anti Her-2 Neu therapy followed by hormonal therapy.