Doctors Fail to Follow Up With Patient Regarding Troubling Mammogram Results

This case involves a female with a family history of cancer. During a self-examination, the patient noted a mass. She saw her OB/GYN, who also palpated the mass. The OB/GYN sent the patient for a diagnostic mammogram. The imaging results revealed a lesion that was highly suspicious for cancer. This report was sent to the OB/GYN, however it does not appear that the OB/GYN ever followed up with the patient regarding the imaging results. The patient was seen by another doctor with concerns about the mass in her breast who sent the patient to a different radiologist for biopsy. That radiologist re-imaged the patient and felt that the lesion was a cyst and that biopsy was not warranted. The patient returned 6 months later and was diagnosed with very advanced breast cancer.

Question(s) For Expert Witness

1. How frequently do you interpret breast ultrasounds and mammographies in your practice?

2. If a breast radiologist disagrees with the interpretation of another radiologist what is the appropriate course of action?

3.What are the risks inherent in performing a needle biopsy of a palpable breast mass?

Expert Witness Response E-143259

I am a board certified radiologist and Fellowship trained in Breast Imaging. I have been practicing Breast Imaging for 22 years. I am the section chief of Breast Imaging at a teaching hospital with a residency training program. I also train a breast imaging fellow in our program each year. I am a reviewer for ACR accreditation on Breast Ultrasound and Stereotactic biopsy, and am the former chairman of the ACR Stereotactic biopsy accreditation program. I interpret Breast ultrasounds and mammograms on a daily basis. The average volume I see is about 50-60 mammographies and 20 Ultrasounds per day. I review many studies from outside facilities with a variety of recommendations from other radiologists. I usually perform my own workup and make a decision based on my imaging rather than relying on the outside images unless the findings are obvious. If I disagree with the initial recommendations I make my a new recommendation which is usually followed, and that can be avoiding a biopsy/aspiration/other procedure or performing one if one was not recommended. There are very few actual risks to biopsy (other than the standard cautions of bleeding, infection, etc) when a breast biopsy is performed in capable, experienced hands. I have never had a serious or significant complication following a breast biopsy that I have performed in over 20 years of practice.