Not Your Regular Case: Surprising Twist

Lee S. Goldsmith, M.D., LLB

Over the years, we have handled many cases in which there was a failure to diagnose breast cancer due to a radiologist's failure to appropriately read and interpret either a mammogram or an ultrasound. The fact patterns were always similar. The woman would responsibly and regularly have her mammogram and if her breast were dense, the mammogram would be followed by an ultrasound.  After two or three years of studies read as normal, the patient would feel a lump and the next radiologist would read the study and find a mass. That mass would be biopsied, the biopsy would reveal cancer and the treatment would begin. A delay of years.

We would obtain copies of all of the films and have them reviewed. The progression of the mass could be seen over the years. Too often, when one radiologist looks at a film and reads it incorrectly, the next radiologist just seems to follow suit without ever critically looking at the film or the prior film. Negligence, without a doubt. 

However, one case we handled was very different and unusual. Ms. M. had her mammography and the radiologist read the film correctly. As Ms. M was young, she wanted her breast reconstructed and, if possible, her own nipple salvaged and used to become an integral part of the reconstructed breast. In order to allow the breast to heal prior to an implant being placed, the salvaged nipple was implanted into Ms. M’s groin. A temporary transplant to remain in her groin for a few months. 

The steps to be taken in the process were: (1) Mastectomy with removal of the nipple. (2) the margins adjacent to the nipple were to be examined to see if any cancer reached the nipple; (3) if no cancer, then the nipple would be implanted and removed at a later date. The pathologist, in examining the tissue, missed the fact that there was obvious evidence of malignancy. The nipple was not a good specimen for re-implantation. 

The nipple implanted in her groin contained cancer cells and those cancer cells spread. All the lymph nodes in her groin became involved with cancer as it spread, and when diagnosed, she had to have major surgery in her abdominal area to remove the cancer and additional radiation to her lower body to stop the spread of the cancer. The case involved from our side, reviews by a radiologist of the films, a pathologist to review the slides and a surgeon to explain all that our client was put through.

In this case, the physicians created metastases through a failure to properly check the slides and allowing the nipple to be implanted in a diseased condition. Those metastases ultimately shortened her life.