Background: Image-guided core biopsy is generally performed for all BI-RADS 4 (suspicious for malignancy) and BI-RADS 5 (highly suggestive of malignancy) lesions. After biopsy, the radiologist compares pathology results with imaging findings to determine concordance. Radiologic-pathologic assessment falls into four categories: concordant or discordant malignant and concordant or discordant benign. Cases are deemed discordant benign when imaging features remain suspicious despite benign pathology or the pathology does not account for the imaging finding. This can be secondary to undersampling or non-target sampling and warrants additional workup such as repeat or excisional biopsy.
Learning Objectives: This exhibit will review the role of the radiologist in radiologic-pathologic correlation, summarize assessment categories and discuss clinical management for discordant benign lesions.
Abstract Content/Results: A case series of approximately ten discordant biopsies will be provided to highlight the clinical importance of radiologic-pathologic correlation. Cases will involve multimodality imaging including MRI, mammography, and ultrasound. Each case will discuss relevant learning points important for radiologic-pathologic correlation. A representative case includes:
A 30-year-old female with a BI-RADS 3 (probably benign) left breast mass presented for a short term follow up ultrasound. Follow up ultrasound demonstrated increased size of mass measuring 36 mm, previously 30 mm. The mass was assessed as BI-RADS 4B. The patient underwent ultrasound-guided biopsy which showed areas of benign breast tissue with large geographic areas of necrosis. The pathologic findings were discordant with imaging findings because the necrosis seen on pathology does not account for the lesion morphology and interval increase in size. The patient underwent excisional biopsy. Final pathology showed malignant phyllodes with high mitotic activity and central infarct type necrosis, concordant with imaging findings. As demonstrated by this case, pathologic findings should account for imaging findings. If they are inconsistent, results are discordant and additional sampling or excisional biopsy should be considered.
Conclusion: At the conclusion of this presentation, the reader will be able to recognize discordant radiographic-pathologic findings and understand the role of the radiologist in clinical management.
