E2359. Concordant or Discordant? A Diagnostic Dilemma
Northwell University Hospital
Breast radiologists play a vital role in determining clinical management of patients after breast imaging biopsies by determining imaging-pathology concordance. This process takes skill, experience, and proper judgement. Although the probability of a false-negative biopsy is low, imaging-pathology correlation is critically important to detect errors in sampling and avoid a delay in diagnosis.
In this presentation, we will use an interactive case-based format to review categories of imaging-pathology correspondence and management strategies.
Educational Goals / Teaching Points
· Sampling error is a major possible limitation and can result in a false-negative diagnosis or histologic underestimation.
· An intact specimen that has >1 cm of uninterrupted length and sinks to the bottom when put into saline suggests adequate sampling and is correlated with diagnostic yield.
· For small lesions, US images may appear as if the needle is within a lesion when it is actually adjacent to the lesion, and additionally obtaining post-fire images in the orthogonal plane can help evaluate the needle position more precisely.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This presentation will review the categories of concordance/discordance & management, and evaluation strategies & tips of adequate targeting, adequate sampling, BIRADS final assessment category, review of pathology: does histology explain imaging. The presentation will also include an interactive case challenge. Multimodality imaging will be reviewed including mammography, tomosynthesis, ultrasound and MRI.
Radiologists performing breast biopsies must be familiar with imaging features of various pathologies within the breast. Careful imaging-pathology correlation and appropriate post-biopsy management is essential to avoid delays in diagnosis and management of breast cancer.