Table 1.
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