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More so in the recent years, we have been treating those patients what’s called neoadjuvantly, which means that they’re going to get systemic, generally IV chemotherapy and anti HER2 treatment upfront prior to the surgery. Now, there is exception if they have very limited disease, meaning very small tumors, and we’re pretty confident that their lymph nodes are negative. If that’s the case, those patients can still go straight to surgery and then afterward, once we have the final pathology, then we can determine if they need further treatment, like the IV chemotherapy of HER2. So patients who do end up going to surgery first, generally we recommend IV chemo and HER2 treatment if the tumor is greater than 0.5 centimeters, or especially if the patient has evidence of lymph node disease on their final pathology,
