Discrepancies between radiological and histological findings in preoperative core needle (CNB) and vacuum-assisted (VAB) breast biopsies

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Abstract

Background

Ultrasound (US)-guided breast biopsy is a routine diagnostic method used to correlate imaging finding to a histological diagnosis which is still the gold standard in preoperative diagnostics. The accuracy of US-guided breast biopsies relies on a precise radiologic-histopathologic correlation, which is discussed amongst an interdisciplinary team of gynecologists, radiologists and pathologists. However, false-negative or non-diagnostic biopsy results occur. Hence, a thorough and honest discussion to clarify the reason for discrepancies and to decide the next diagnostic step between specialists of the different disciplines is warranted. In this retrospective study, we analyzed discrepant findings between imaging and pathology results on preoperative breast biopsies.

Methods

Core and vacuum-assisted breast biopsies from 232 patients were included in this study. Inclusion criteria were (1) non-diagnostic (B1) category on histology independent from imaging category and (2) histological benign (B2) category with a BIRADS 5 (Breast Imaging Reporting and Data System) rating on imaging. Histological diagnoses were retrieved from all cases. Follow-up data were available in most cases.

Results

138 biopsies were classified as B1, 94 biopsies as B2 category. 51 of 138 B1 cases (37%) underwent re-biopsy. Re-biopsy found malignancy (B5) in 19 of 51 cases, and B3/4 (premalignant) lesions in 3 of 51 cases. All B2 cases underwent second-look imaging-diagnosis, in 57 of 94 cases (66%) consecutive direct surgery or re-biopsy. Of these, malignancy was diagnosed histologically in 26 of 57 cases (45.6%).

Conclusion

Determining imaging-pathology concordance after US-guided breast biopsy is essential. Discrepant cases and further diagnostic steps need to be discussed with an interdisciplinary approach.

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Most cited references 19

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Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound.

Hye-Jeong Lee, Eun-Kyung Kim, Min Kim … (2008)

To evaluate inter- and intra-observer variabilities in breast sonographic feature analysis and management, using the fourth edition of the Breast Imaging Reporting and Data System (BI-RADS). We included 136 patients with 150 breast lesions who underwent breast ultrasound (US) and ultrasound-guided core needle biopsy. A pathological diagnosis was available for all 150 lesions: 77 (51%) malignant and 73 (49%) benign. Four radiologists retrospectively reviewed sonographic images of lesions twice within an 8-week interval. The observers described each lesion, using BI-RADS descriptors and final assessment. Inter- and intra-observer variabilities were assessed with Cohen's kappa statistic. Positive predictive value and negative predictive value (NPV) for final assessment were also calculated. For inter-observer agreements for sonographic descriptors, substantial agreement for lesion calcification and final assessment (kappa=0.61 for both), moderate agreement for lesion shape, orientation, boundary, and posterior acoustic features (kappa=0.49, 0.56, 0.59, and 0.49, respectively), and fair agreement for lesion margin and echo pattern (kappa=0.33 and 0.37, respectively) were obtained. For intra-observer agreement, substantial to perfect agreement was found for almost all lesion descriptors and final assessments. NPV for final assessment category 3 was 95%. Positive predictive value (PPV) for final assessment categorized as 4 or 5 were as follows: category 4a, 26%; category 4b, 89%; category 4c, 90%; and category 5, 97%. Because inter- and intra-observer agreement with the BI-RADS lexicon for US is good, the use of BI-RADS lexicon can provide accurate and consistent description and assessment for breast US.

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Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography.

Jin Kwak, Byeong-Bae Park, Joshua Ko … (2008)

The objective of our study was to report the results of classification of sonographic findings according to BI-RADS and to calculate the positive predictive value (PPV) for each BI-RADS assessment category. We prospectively classified 4,668 breast sonograms according to BI-RADS final assessment category. Suspicious sonographic findings were divided into major and minor suspicious findings. Category 1 was normal and category 2 was a benign finding such as cyst or nodule with uniform and intense hyperechogenicity. A nodule neither category 2 nor category 4 or 5 was defined as category 3. A nodule with one or more suspicious findings, not category 5, was defined as category 4. A nodule with two or more major suspicious findings was defined as category 5. Of the 4,668 cases, 321 cases failed to undergo follow-up of at least 1 year. The PPV was 0.1% in category 1 (3/2,191), 0% in category 2 (0/773), 0.8% in category 3 (6/737), 31.1% in category 4 (161/519), and 96.9% in category 5 (123/127). In palpable lesions (n = 751), the PPV was 2.2% in category 1 (2/93), 0.9% in category 3 (2/217), 54% in category 4 (107/198), and 98% in category 5 (98/100). In nonpalpable lesions (n = 3,596), the PPV was 0.05% in category 1 (1/2,098), 0.8% in category 3 (4/520), 16.8% in category 4 (54/321), and 92.6% in category 5 (25/27). As with mammography, placing sonographic lesions into BI-RADS categories is useful for predicting the presence of malignancy.

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Missed breast cancers at US-guided core needle biopsy: how to reduce them.

Ji Youk, Eun-Kyung Kim, Min Kim … (2015)

Ultrasonographically (US) guided core needle biopsy is currently recognized as a reliable alternative to surgical biopsy for the histopathologic diagnosis of breast lesions. However, despite advances in biopsy devices and techniques, false-negative diagnoses are unavoidable and may delay the diagnosis and treatment of breast cancer. The most common reasons for false-negative diagnosis are (a) technical or sampling errors, (b) failure to recognize or act on radiologic-histologic discordance, and (c) lack of imaging follow-up after a benign biopsy result. Technical difficulties (eg, poor lesion or needle visualization, deeply located lesions, dense fibrotic tissue) cause inaccurate sampling but can be reduced by using modified standard techniques. Radiologic-histologic correlation is also of critical importance in US-guided core needle biopsy. Radiologic-histologic discordance occurs when the histologic results do not provide a sufficient explanation for the imaging features and indicates that the lesion may not have been sampled adequately, so that repeat biopsy is warranted. Appropriate follow-up imaging is invaluable; even patients with concordant benign findings after US-guided core needle biopsy are directed to undergo follow-up imaging because there may be delays in the recognition of false-negative findings. Optimization of technique, radiologic-histologic correlation, and postbiopsy follow-up protocols are recommended to reduce the occurrence of false-negative diagnosis at US-guided core needle biopsy performed by radiologists. Copyright RSNA, 2007.

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Author and article information

Contributors

Zsuzsanna Varga:

ORCID: http://orcid.org/0000-0002-2855-983X

zsuzsanna.varga@usz.ch

Journal

Journal ID (nlm-ta): J Cancer Res Clin Oncol

Journal ID (iso-abbrev): J Cancer Res Clin Oncol

Title: Journal of Cancer Research and Clinical Oncology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0171-5216

ISSN (Electronic): 1432-1335

Publication date (Electronic): 7 December 2020

Publication date PMC-release: 7 December 2020

Publication date (Print): 2021

Volume: 147

Issue: 3

Pages: 749-754

Affiliations

[1 ]Department of Gynecology, Hospital Triemli, Zurich, Switzerland

[2 ]GRID grid.412004.3, ISNI 0000 0004 0478 9977, Institute of Diagnostic Radiology, , University Hospital Zurich, ; Zurich, Switzerland

[3 ]GRID grid.476941.9, Breast Center Seefeld, ; Zurich, Switzerland

[4 ]GRID grid.412581.b, ISNI 0000 0000 9024 6397, Department of Radiology, , University Witten-Herdecke, ; Witten, Germany

[5 ]Department of Gynecology, Hospital Zollikerberg, Zollikerberg, Switzerland

[6 ]Department of Gynecology, Hospital Männedorf, Zurich, Switzerland

[7 ]GRID grid.412004.3, ISNI 0000 0004 0478 9977, Breast Center, , University Hospital Zurich, ; Zurich, Switzerland

[8 ]GRID grid.412004.3, ISNI 0000 0004 0478 9977, Comprehensive Cancer Center Zurich, , University Hospital Zurich, ; Zurich, Switzerland

[9 ]GRID grid.412004.3, ISNI 0000 0004 0478 9977, Institute of Pathology and Molecular Pathology, , University Hospital Zurich, ; Schmelzbergstrasse 12, 8091 Zurich, Switzerland

Author information

Zsuzsanna Varga http://orcid.org/0000-0002-2855-983X

Article

Publisher ID: 3481

DOI: 10.1007/s00432-020-03481-7

PMC ID: 7873108

PubMed ID: 33284380

SO-VID: b49928e1-a8b9-4972-9792-3931e83a69fb

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 27 July 2020

Date accepted : 22 November 2020

Funding

Funded by: University of Zurich

Open Access :

Open access funding provided by University of Zurich

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: breast biopsy,discrepancy,imaging,histology

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: breast biopsy, discrepancy, imaging, histology

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Discrepancies between radiological and histological findings in preoperative core needle (CNB) and vacuum-assisted (VAB) breast biopsies

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Abstract

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Cancer Immunotherapy

Most cited references 19

Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound.

Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography.

Missed breast cancers at US-guided core needle biopsy: how to reduce them.

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