The Importance of Radiology and Pathology Communication in the Diagnosis and Staging of Cancer: Mammography as a Case Study. 4.3 Availability of literature and data on breast cancer discordance


Several studies assessed the frequency of radiologic-pathologic discordance of percutaneous breast biopsies. In a study conducted at the Kettering Cancer Center in New York, Liberman et al. found that imaging-histologic discordance was present in 3.1 percent of examined lesions. 11 Similarly, Lee et al found a discordance rate of 7 percent between radiologist and pathologist findings. 14 Some studies evaluated discordance in benign biopsies. Mihalik et al. found that 2 percent of benign breast cases were discordant. 15 Overall, the rates of radiologic-pathologic discordance of percutaneous biopsy have usually ranged from 1 percent to 6 percent. 3

Moreover, discordance of radiologic-pathologic findings can have serious consequences in failing to properly diagnose carcinoma. 8,11 Further investigations of discordant cases play a significant role in identifying previously misdiagnosed or missed malignant lesions. In one study, one discordant case out of 25 benign cases was found to be malignant after open excision, giving a false-negative rate of 4 percent. 15 Liberman et al. identified carcinoma in 24.4 percent of discordant lesions after performing repeat biopsy. 11 Lee et al. detected cancer in 30 percent of discordant cases after subsequent surgical excisions, including cases of both ductal carcinoma in situ and invasive carcinoma. 14 Carcinoma was found in 11.1 percent of benign biopsies that underwent subsequent ultrasound-guided directional vacuum-assisted removal (DVAR) and 12.5 percent of cases that underwent surgical excisions. 3

In addition, unpublished data of a pilot study conducted at KUMC supports the published literature discussed above. Collaboration between radiologists and pathologists through multidisciplinary conferences at KUMC (additional information on KUMC’s multidisciplinary model discussed below) to resolve discordant benign cases helped identify missed cancer cases and changed the treatment plans for several patients. This data and how it was used to estimate the population-level impact of discordance are described below under the section discussing the public health impact of discordance.

Overall, the results of the published literature and unpublished data clearly indicate a significant problem with discordance and the importance of resolving any discordance between radiology and pathology findings. In some cases, this involves performing additional diagnostic studies at the  time of pathologic examination.

Table 1 below shows six data items for which radiologic values are typically established before breast biopsy that need to be correlated with pathologic findings at the time of pathologic examination.

Table 1 : Radiologic-Pathologic Data Items for Breast Biopsy

Radiologic data item Pathologic data item

Calcification and pattern


Tumor size

Tumor size

Localizing wire

Wire location

Contiguous involvement

Margins and contiguous involvement

Number of discrete abnormalities

Number of discrete tumor foci

Degree of clinical suspicion (e.g. BI-RADS score)

Final pathological diagnosis

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