36C10X19Q0200-010.pdf

Patient: Provider: Case ID:

This document is confidential and privileged under the provisions of 38 U.S.C. § 5705, and its implementing regulations. This material cannot be disclosed to anyone without authorization as provided for by that law or its regulations. The statute provides for fines up to $20,000 for unauthorized disclosures.

Timeliness and/or appropriateness of diagnosis.

Recognition and communication of critical clues to patient’s clinical condition.

Timely initiation of appropriate actions during periods of clinical deterioration.

Health record documentation.

Supervision of health profession trainees.

Please summarize your assessment of this case giving your rationale for the level of care selected above. Please include any comments that you think are relevant to your findings and include references or other resources that were used in making your final determination.

The mammography guided wire localization of breast masses was performed and reviewed.

Two masses were present and clipped with different size/shape clips. One was in the anterior third 12:00 about 5cm from the nipple and has a larger barrel shape clip. The other was in the posterior third also roughly 12:00 about 10-12 cm from the nipple. The more posterior/deep mass was a suspicious spiculated mass. It has the smaller clip.

The larger barrel shape clip in the anterior mass was the one localized with a wire, and specimen mammography showed excision of the anterior mass and large barrel clip. The spiculated mass in the posterior depth of the right breast was not localized but was seen on the final localization CC and ML images as roughly 10-12cm from the nipple. The more suspicious appearing mass with a smaller biopsy clip in the posterior third of the right superior breast was not targeted. The more anterior mass with a larger biopsy clip was the one targeted.

Both masses on the stereotactic images were roughly at the 12 o'clock position which could have been due to breast positioning.

The masses were not well seen on mammography and therefore location was not fully described. The masses on ultrasound were breast positioning dependent and technologist dependent.

Since breast positioning in ultrasound technique can be variable from breast positioning in the mammographic technique, it was important that the evaluation and biopsy of multiple masses be clearly delineated to avoid confusion during future surgical management. The depth of the lesions in a supine breast may be calculated differently from the positions on a mammogram image.

Review of all prior imaging and appropriate targeting of the more suspicious lesion should be done and confirmed prior to targeting for wire localization.

Most experienced and competent clinicians would have managed the case differently.

Reviewed by:

Specialty: Date Completed:

Patient: Provider: Case ID:

This document is confidential and privileged under the provisions of 38 U.S.C. § 5705, and its implementing regulations. This material cannot be disclosed to anyone without authorization as provided for by that law or its regulations. The statute provides for fines up to $20,000 for unauthorized disclosures.

Diagnostic, Interventional Radiology, Nucleau Medicine