E2320. Clinical Management and Pathological Outcomes of the Radiological-Pathological Discordance in Image-Guided Breast Core Needle Biopsy
  1. Xiaoqin Wang; University of Kentucky
  2. Fara Shikoh; University of Kentucky
We were to assess the false negative rate of radiological-pathological discordance after image-guided core biopsy in an academic center and review the clinical management of these discordance to determine pathological outcomes of discordant cases following the recommended management.

Materials and Methods:
This is an IRB-approved, single institution retrospective chart review. Charts for all women who underwent breast biopsy at a comprehensive breast care center from 1/3/2014-9/30/2019 were reviewed. Pathological results from initial biopsies were correlated with radiological images by a breast radiologist. Discordant cases were assessed by a multidisciplinary team, including a radiologist, pathologist, surgeon, and oncologist. Management plans were determined by the team. All women with discordant radiological-pathological results were included in this study. Patient demographics, discordance rate, initial biopsy results, recommended management, and final pathological outcomes of discordance cases were collected and analyzed.

5112 patients underwent percutaneous breast biopsy in our breast imaging center within the study period. A total of 101 (2%) rad-path discordant cases with non-malignant pathological results on initial biopsy in 99 patients (mean age 54, age range 18-82) were investigated. Types of procedures included 42 stereotactic-guided biopsies and 59 US-guided biopsies. 5 patients failed to return, 96% of patients followed management recommendations: 51 (53.4%) repeat biopsies, 37 (36.6%) 6-month imaging follow-up, 3 (2.9%) surgical excision, and 2 (1.9%) clinical management. In total, 5 cancer cases were detected upon repeat biopsy, including 3 DCIS, 1 invasive ductal carcinoma, and 1 invasive lobular carcinoma. No malignancy was found in 96 of the discordant cases that were managed with imaging follow-up, surgical excision, repeat biopsy or clinical follow-up. The false negative rate on initial biopsy of discordant cases was 5% (5/101).

While radiological-pathological discordance rate for the initial image-guided core breast biopsy is low (2%), the false negative radiological-pathological discordance can be up to 5%, which warrants further careful management. Repeat biopsy only half of the discordant cases selected by the multidisciplinary team detected all cancers missed on initial biopsy. Rigorous evaluation of radiological-pathological correlation plus proper management of patients by a multidisciplinary team allows for detection of missed cancer and avoiding unnecessary surgical excision or repeat biopsy.