Patient Question:Description:Female, 38 years old, married, one pregnancy and one delivery.On July 28, 2011, modified radical right breast surgery was performed. Postoperative pathological diagnosis: High-grade intraductal carcinoma of the right breast, focal with microinfiltration. Immunohistochemistry: Her-2 (2+), ER (30%, weak +), PR (90% +), Ki-67 index 10%. On December 16, 2013, PET MRI: hypermetabolic nodule in the right lobe of the liver, metastatic lesion was considered. on December 27, 2013, laparoscopic resection of right liver tumor was performed. Postoperative pathology: metastatic right hepatic tumor consistent with proto-mammary invasive ductal carcinoma, moderately differentiated, immunohistochemistry: ER (+>75%), PR (-), Her-2 (2+), KI-67 (+50%). Postoperatively, Norelide was given as a 3-month dose subcutaneously and anastrozole 1 mg daily. on August 4, 2014, abdominal MRI scan plus enhancement: multiple metastases in the liver Q: 1. The hospital where the patient is currently seen considers the patient to be hormone-dependent and recommends chemotherapy after removal of the ovaries. I would like to ask your opinion whether it is necessary to remove the ovaries? Is chemotherapy necessary and what is the specific opinion of the chemotherapy regimen? 2. What is the possibility of cure or the probability of survival under the current situation? 3.When the mastectomy was performed in 2011, the hospital judged that it was in the early stage, but it still metastasized, does this patient’s breast cancer have special characteristics? I will answer your questions one by one: 1. The patient is hormone-dependent, but at present, the patient’s visceral metastasis is progressing, so removal of ovaries is not a priority, and the patient needs systemic chemotherapy. However, before chemotherapy, I hope you will perform FISH on the patient’s HER2 to clarify its expression, which is very important for choosing a treatment plan for the patient. If HER2 is overexpressed, a Herceptin-containing chemotherapy regimen is needed. 2. In the current situation for breast cancer liver metastasis. Once metastasized, there is little possibility of cure, but the patient can survive with tumor for a long time with appropriate treatment. 3.The hospital’s conclusion that it was early stage when mastectomy was performed in 2011 was correct. “The breast cancer was intraductal with microinfiltration and no lymph node metastasis”. There is no way to say whether this patient’s breast cancer was specific, except that the patient was young and whether endocrine therapy was adhered to, while HER2 expression was unclear, which is a poor prognostic factor if HER2 is overexpressed. If HER2 is overexpressed in the in situ part of the cancer, it has no significance for in situ Herceptin treatment, but if the HER2 is overexpressed in the infiltrating part of the cancer, it has prognostic and therapeutic significance. Of course, since the patient has liver metastasis, this significance is no longer important. The important thing is whether HER2 is overexpressed or not, so please perform FISH examination as soon as possible to verify it in order to guide further treatment.