A 40-year-old woman with early-stage triple-negative breast cancer and a retinal lesion

The development of highly sensitive diagnostic imaging tools has created a challenge in localized cancer therapy; incidental findings can complicate staging and decision making. In the absence of clinical symptoms suggestive of metastatic disease, the diagnostic approach to localized breast cancer typically does not mandate staging scans. While metastatic disease is often referred to as an incurable entity, oligometastatic disease, confined to a limited number of sites, may be amenable to curative-intent ablative therapy. There is a growing body of evidence supporting the deployment of multidisciplinary treatment involving radiotherapy and/or surgical intervention in oligometastatic disease. This report describes a 40-year-old woman with triple-negative breast cancer who was incidentally found to have an right chorioretinal lesion, identified on a routine annual eye exam prior to her breast cancer diagnosis, with ophthalmic features suggestive for metastatic disease. She was asymptomatic, and did not have other findings suggestive of metastatic disease. Staging CT chest/abdomen/pelvis and brain MRI were negative. Biopsy of the ocular lesion was deferred given its close proximity to the macula and potential for vision threatening complications. Curative-intent localized treatment was undertaken, and the retinal lesion was monitored with serial ophthalmologic examinations. The patient received neoadjuvant chemotherapy, followed by bilateral mastectomy, and adjuvant chemotherapy. Follow-up imaging remained negative for disease progression, and routine ophthalmic exams over years of follow up showed no changes to the retinal lesion. The patient granted verbal consent to share her clinical story, imaging, and data.