Adaptation of international coronavirus disease 2019 and breast cancer guidelines to local context

Table 4 Priorities for diagnostic and imaging of breast cancer

High priority	Medium priority	Low priority	Comments
(1) Clinical diagnosis: (a) Diagnosis of a mass or lump (auto examination) or other signs with high suspicion of malignancy (Yes: 100%, No: 0%); and (b) Clinical evidence of relapsed locoregional disease (Yes: 100%, No: 0%); (2) Imaging: (a) Urgent situations that require imaging (oncological emergencies, serious postsurgical complications, etc.) (Yes: 100%, No: 0%); (b) Perform additional images upon abnormal mammogram results or suspected metastasis (depending on clinical stage and tumor biology) (Yes: 89%, Abst: 11%); and (c) Images for relapsed BC (Yes: 100%, No: 0%); and (3) Pathological diagnosis: Pathologic evaluation (cytopathology or histopathology) for abnormal mammograms or symptoms in the breast or symptomatic metastatic relapse (Yes: 100%, No: 0%)	(1) Imaging: (a) Perform additional images upon abnormal mammogram results or suspected metastasis (depending on the clinical stage and tumor biology) (Yes: 100%, No: 0%); and (b) Echocardiograms (every 6 mo, if feasible) in patients who require treatment based in anthracyclines or anti-HER2 agents (Yes: 78%, No: 22%); (2) Pathological: (a) Biopsy for BIRADS 4 or 5 lesions (Yes: 100%, No: 0%); and (b) Image-guided (or clinically) biopsy to determine a metastatic relapse (note: metastatic relapses should not be 100% biopsies) (Yes: 100%, No: 0%)	(1) Screening: All screening exams (mammograms or images) for symptomatic patients (e.g., ultrasound or MRI) may be performed after pandemic (Yes: 100%, No: 0%)—BRCA mutated carriers < 40 yr may be considered for screening if delays or more than 6 mo are expected[6,7]; and (2) Follow-up: (a) EBC patients that require images, reevaluation of disease, echocardiograms, and bone scans, should be deferred if patients are clinically asymptomatic (Yes: 100%, No: 0%); and (b) In MBC patients, follow-up oriented to symptoms is recommended. Images, disease reevaluation, echocardiograms may be deferred in large intervals (Yes: 100%, No: 0%)	All patients with a new mass lump with a high suspicion of malignancy or who have already undergone imaging with a high suspicion for malignancy (e.g., BIRDAS 5 in mammogram) should be immediately referred for histological diagnosis and imaging, as a high priority

BC: Breast cancer; BIRADS: Breast Imaging Reporting and Database System score; EBC: Early BC; MBC: Metastatic BC; MRI: Magnetic resonance imaging.