Surgeon Fails to Remove Malignant Tissue in Patient With Breast Cancer

Case Overview

This case involves a thirty-eight-year-old female patient who was undergoing treatment for breast cancer. Following a sentinel node biopsy, she was diagnosed with invasive ductal carcinoma with two positive lymph nodes in the left breast. The patient underwent a bilateral mastectomy with the axilla being left intact. The patient underwent a successive follow-up mammogram that revealed a subcentimeter area of tissue nodularity on the mid lower left axilla. An ultrasound guided needle biopsy revealed a recurrence of the adenocarcinoma in the axillary region. The patient was seen by a different oncology team who questioned why she had the lymph node biopsy before the original surgery, and also noted that the patient had significant breast tissue present in the upper parts of the breast. They also noted that this residual breast tissue should have been resected during the double mastectomy. The patient underwent an additional surgery with the axilla being removed. The patient underwent multiple rounds of chemotherapy using Taxotere with a poor prognosis due to late intervention in the axillary region.

Questions to the Hematology expert and their responses

Did the decision to not remove the axilla in this patient directly cause the recurrence in this patient?

In more recent years, large randomized trials have shown that neither the extent of the mastectomy nor delay in the treatment of the axilla has any influence on the prognosis of patients with operable breast cancer.

About the expert

This expert is board certified in Hematology & Oncology with additional research training in hereditary breast and ovarian cancers. He received his medical training at the Long Island Jewish Hillside Hospital Medical Center was formerly the Clinical Professor in the Department of Hematology & Oncology at a major university medical center in New York. Furthermore, he is currently on staff as an affiliated attending with privileges at several New York Hospital and is also the director of Medical Oncology at a private practice.