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.
Question(s) For Expert Witness
- 1. Did the decision to not remove the axilla in this patient directly cause the recurrence in this patient?
Expert Witness Response E-000029
Patients with four or more involved nodes at initial diagnosis have a significantly worse outcome after relapse than node-negative cases, regardless of the duration of the disease-free interval. 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. It is uncommon to have a regional recurrence in only the lymph nodes under the arm. Fewer than 5% of women treated for breast cancer have recurrence that happens this way. Instead, the cancer generally comes back in both the lymph nodes and inside the breast or in the tissues of the chest wall.