Source: Radio New Zealand
It was in the fourth biopsy that the woman was confirmed to have gastric adenocarcinoma – stomach cancer. 123rf
A 74-year-old woman’s cancer diagnosis was delayed by nine months after three biopsies missed signs of cancer, and she died the following year.
The Health and Disability Commissioner has found Awanui Labs, and the doctors responsible for her care, erred in their treatment.
Mrs A, a retired nurse and caregiver for her husband, was in “excellent health of body and mind”, until in 2021 she was referred to Southland Hospital by her GP for recurrent gastrointestinal bleeding.
Biopsies in April, June and October 2021 came back as benign, with no malignancy. But a fourth in December 2021 confirmed gastric adenocarcinoma – stomach cancer.
Following that diagnosis, a review of the earlier samples found cancer cells were present in April and October, but had been missed.
“Sadly, despite [her doctor’s] urgent referral and the cancer treatment received after her diagnosis had been confirmed, Mrs A passed away on 17 May 2022.”
Response from Awanui Labs
In response to the commissioner’s investigation, Awanui Labs, known at the time as Southern Community Laboratories, acknowledged there were errors in diagnosis in May and October 2021.
“[The] May diagnosis missed a subtle area of cancer. The diagnosis of limited (small) amounts of poorly differentiated gastric adenocarcinoma is difficult.”
Regarding the incorrect diagnosis in October, it said its pathologists had been influenced by a lack of clinical suspicion for cancer in the referral, alongside the two previous negative results.
“Anatomical pathologists cannot perform optimally unless they have access to all relevant clinical information, and if the request forms had been more fulsome, it is likely that the negative slides would have had more scrutiny back in May 2021 and the correct diagnosis of gastric adenocarcinoma made at that time.”
The doctors responsible for the misdiagnoses individually apologised for the mistakes, with one saying she wished she “could go back to that time and change things”.
Health NZ Southern responded that the underlying reason for providing a biopsy was to establish a diagnosis.
“It is not reasonable to suggest that the request for analysis of a biopsy not stating a high suggestion of cancer is at the root cause of the cancer not being identified.”
However, it did acknowledge that the work was challenging and “always made easier in hindsight”.
Ultimately, Mrs A’s treatment was delayed by nine months. Experts note in the report even a two-month delay would have led to “clinically meaningful cancer growth”, due to the aggressive nature of her cancer.
In her final report, Deputy Health and Disability Commissioner Vanessa Caldwell recommended those at fault provide written apologies to Mrs A’s family.
HDC finds breaches of code
Awanui Labs was found to be in breach of code for failing to ensure its pathologists provided the right diagnosis.
But only one doctor – the lead GI pathologist – was found in breach of code. The others had either sought a second opinion, or made mistakes that other doctors would have made, according to a blind review.
The surgeon should have noted his suspicions for cancer in his biopsy request, it found, which would perhaps have made the pathologists more cautious.
Since the incident, the doctors involved had sought additional training, or changed their practices to include more information in requests.
Awanui Labs said all pathologists were now required to look up the patient’s endoscopy report at the time of the biopsy, to make sure it had all the relevant information regarding suspicions of cancer.
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– Published by EveningReport.nz and AsiaPacificReport.nz, see: MIL OSI in partnership with Radio New Zealand