Discordances Between Radiology and Pathology

Radiology-pathology correlation is important and recommended for all breast biopsies. The correlation can be done by individual pathologists as well as implemented systematically in a regular weekly conference. Percutaneous biopsies are performed under sonographic guidance for lesions identified on ultrasound. Stereotactic biopsies are performed for calcifications and other mammographic lesions (mass, asymmetry, and architectural distortion) without an ultrasound correlate. MRI-guided biopsies are restricted to lesions seen only on MRI. A lesion is considered concordant when the imaging features correspond to the pathologic findings. When imaging characteristics are different from the pathologic findings the biopsy is considered discordant. In discordant cases the lesion may not have been accurately sampled and a discussion between the radiologist and pathologist to clarify the potential cause for discordance is warranted. This may require the pathologist to evaluate the biopsy with additional techniques such as obtaining deeper H&E levels and doing ancillary stains to resolve the discordance. However, if the discordance cannot be resolved following a discussion between specialists and the biopsy is scant, a repeat image-guided preoperative biopsy or surgical excision is a necessary next step to avoid a false-negative diagnosis. Even if the imaging characteristics are benign and the histopathologic findings are malignant, review of the imaging characteristics to determine concordance is desirable.