Table 1.

Priority categories for surgical oncology

Priority	Patient description	COVID-19 treatment considerations
Priority A
A	Breast abscess in a septic patient	Operative drainage if unable to be drained at the bedside
A	Expanding hematoma in a hemodynamically unstable patient	Operative evacuation and control of bleeding
Priority B
B1	Ischemic autologous tissue flap	Revascularize or remove flap
B1	Revision of a full thickness ischemic mastectomy flap with exposed prosthesis	Debride and remove expander/implant
B1	Patients who have completed neoadjuvant chemotherapy for Inflammatory BC	Operate as soon as possible depending on institutional resources*
B1	TNBC and HER2 + patients	Neoadjuvant chemotherapy or HER2 targeted therapy. In some cases, institutions may decide to proceed with surgery first versus neoadjuvant therapy. These decisions will depend on institutional resources and patient factors.*
B2	Neoadjuvant: -finishing treatment -progressing on treatment	Operate if feasible depending on resources or extend/change neoadjuvant therapy*
B3	Clinical Stage T2 or N1 ER + / HER2 – tumors	Consider hormonal treatment, delay operation
B3	Discordant biopsies likely to be malignant	Perform excisional biopsy when conditions allow
B3	Malignant or suspected local recurrence	Begin with staging when feasible. Perform excision when conditions allow if there is no distant disease
Priority C
C1	ER–DCIS	Delay operation until after COVID-19 unless there is a high risk of invasive cancer (Move to B3)
C1	Positive margin(s) for invasive cancer	Delay re-excision until after COVID-19
C1	Clinical Stage T1N0 ER + / HER2—cancers	Hormonal treatment; delay operation until after COVID-19
C1	BC patients requiring additional axillary surgery	Delay operation until after COVID-19
C2	ER + DCIS	Hormonal treatment; delay operation until after COVID-19
C2	High-risk lesions	Delay operation until after COVID-19
C2	Reconstruction for previously completed mastectomy	Delay operation until after COVID-19
C3	Excision of benign lesions-fibroadenomas, nodules, papillomas, etc	Delay operation until after COVID-19
C3	Discordant biopsies likely to be benign	Delay operation until after COVID-19
C3	Prophylactic surgery-for cancer and noncancer	Delay operation until after COVID-19

^*Breast conservation is preferred provided that radiation oncology services are available, and the risk of multiple visits or deferred radiation is acceptable. If no ventilator is available or risk of viral exposure is high, breast conserving surgery could be performed under local with sedation. Reconstruction should be limited to tissue expander or implant placement if necessary depending on institutional resources. Autologous reconstruction should be deferred

BC breast cancer, TNBC triple negative breast cancer, ER estrogen receptor, HER2 human epidermal growth factor receptor 2, DCIS ductal carcinoma in situ