Introduction and General Consideration of Radiology-Pathology Correlation

The accurate diagnosis of breast lesions involves the careful correlation of imaging with histopathologic findings of the disease. This complex exercise involves identifying and procuring the target tissue by a radiologist and histological examination of that tissue by a breast pathologist. Understanding the various nuances of imaging and pathology reporting is critical for the practicing radiologist and pathologist involved in patient care. The sophistication of breast imaging has grown by leaps and bounds over the last two decades. Full-field digital mammography (FFDM), introduced in the late 1990s and early 2000s, signaled the start of a new era (Basset et al. Radiol Clin North Am. 45:881–94, 2007). Several studies demonstrated increased cancer detection rates and decreased interval cancer rates with FFDM compared to screen-film mammography (Basset et al. Radiol Clin North Am. 45:881–94, 2007; Jakman et al. Radiology. 210:799–805, 1999). The breast pathologists have adapted to the evolving radiology field. Pathologists utilize various strategies to work up the tissue samples. For example, imaging of tissue blocks as well as performing multiple deeper tissue levels to find calcifications, mass lesions or biopsy clips. In this book, we will share these simple but essential steps that are needed for the optimal workup of the breast tissue samples. It is more important than ever for radiologists to understand the basis of breast pathologists’ work and vice versa. While advancing imaging technologies allow for better characterization of lesions, there is a growing need for communication between pathologists, radiologists, and surgeons to resolve discordant findings seen on core needle biopsies. This is generally achieved through a regularly scheduled multidisciplinary meeting. Increasingly, both pathology and radiology reports incorporate images as well as text. Integrated, image-rich reports, where essential radiology and pathology images will be included alongside descriptions of radiologic and pathologic findings are the next step. Therefore, radiologists and pathologists will literally have to be “on the same page” and establish a consensus as to which images should be included in a report to maximize its value to the clinician. Our aim for this book is to create an easy-to-use reference for radiology and pathology residents and fellows, as well as practicing pathologists and radiologists, which would integrate the radiologic and pathologic appearance of relatively common breast lesions side-by-side, with easy-to-understand descriptions and illustrations. As many centers are now introducing regular radiology-pathology conferences, there is a growing need for a reference radiology-pathology correlation book. Each chapter will have an outline with a systematic approach to each disease entity punctuated by various imaging techniques, key diagnostic points seen on imaging and pathology followed by diagnostic considerations. Towards this end, we have included contributions from national experts, with vast knowledge and years of experience in the field of radiology and pathology.