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E2320. Clinical Management and Pathological Outcomes of the Radiological-Pathological Discordance in Image-Guided Breast Core Needle Biopsy
Authors
  1. Xiaoqin Wang; University of Kentucky
  2. Fara Shikoh; University of Kentucky
Objective:
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.

Results:
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).

Conclusion:
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.