The Importance of Radiology and Pathology Communication in the Diagnosis and Staging of Cancer: Mammography as a Case Study. 4.5 The Availability of data that allows the public health impact of discordance to be estimated


Increased concordance of pathology results with imaging findings will not only change some individual diagnoses but will have an impact on population morbidity and mortality and may improve the quality and efficiency of cancer treatment. Although it is difficult to determine its exact impact, an estimation of the number of missed breast cancer diagnoses can be suggested.

Based on the pilot study conducted at KUMC, 321 benign biopsy results were selected for radiology and pathology review. Of these 321 cases, 61 were found to have discordant results and upon further examination, four cases were found to be malignant. Using these results and projecting on a population level, (based on approximately one million needle biopsies performed per year in the US for the diagnosis of breast cancer with approximately 200,000 positive cases) 10-12,16 , we can estimate that approximately 9,969 missed cancer diagnoses per year ( Figure 1 ) could be treated earlier if radiology-pathology concordance processes were implemented nationwide. The American Cancer Society estimates that there will be 207,090 new breast cancer cases in 2010. 16 Hence, this group of missed or delayed diagnoses could represent about an additional 5 percent of these new cases.

We also completed these calculations using comparable data reported in a number of published studies. 3,17,18 The results of these calculations are reported in Table 2 . Although the results show a broad range of values, the group favors a value between 5,000 and 10,000 cases annually. However, additional studies are warranted in order to produce estimates with appropriate confidence levels.

Figure 1 : KUMC Pilot Study Results

Graphic. Pilot Study results.  KUMC Path-Rad Correlation Data - Dr Tawfik re-calculations 3.     

This figure presents the data from the KUMC pilot study including the original number of benign biopsy cases selected for the radiology-pathology review, number of concordant and discordant cases, the number of major and minor discordant cases, and the number of malignant cases found after establishing concordance.   The national impact is estimated as follows:

Delayed carcinoma diagnosis rate found after concordance meetings: 4/321 = 0.0125

Estimated number of missed cancer cases nationally:

800,000 benign breast needle biopsies year X (0.0125) = 9,969 delayed cases.

Table 2 : Public Health Impact Estimates of Annual Breast Cancers in the United States from Published Studies

Author  Identified Malignant Cases Benign Biopsy Cases Estimated Missed Cases Comments
Kim, 2007 3 634 3,785  
Kim, 2008 2 386 4,145 Note that an additional 11 malignancies were diagnosed in the biopsy negative non-discordant population.
Youk, 2010 28 1,706 13,130 study found 50 malignant cases, but only 28 were due to imaging-histologic discordance


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