Radiologic-Pathologic Discordance After Image-Guided Breast Biopsy: A Systematic Review of Prevalence and Outcomes

Area of Science:

• Radiology
• Pathology
• Oncology

Background:

• Radiologic-pathologic discordance is a significant concern in breast imaging due to a lack of standardized guidelines.
• Discordant benign outcomes, where imaging findings are suspicious but biopsy is benign, require further investigation.
• Malignancy upgrades after initial benign biopsy highlight the need for careful correlation.

Purpose of the Study:

• To systematically review and summarize the prevalence of discordant benign outcomes in breast imaging.
• To quantify the rate of malignancy upgrades following initially benign but discordant biopsy results.
• To identify areas for improvement in diagnostic algorithms and management.

Main Methods:

• Systematic review adhering to PRISMA 2020 guidelines, prospectively registered.
• Inclusion of studies reporting patient-level or aggregated data on radiologic-pathologic correlations post-image-guided breast biopsy.
• Extraction of data on discordant benign prevalence and subsequent malignancy upgrade rates.

Main Results:

• Unselected cohorts reported 1.2-5.3% discordant benign prevalence for all biopsies.
• Excised lesion analysis showed a 7.4% discordant benign ascertainment rate.
• Malignancy upgrade rates in discordant benign cases ranged from 0-100%, with representative rates around 20-40% in clinically relevant cohorts.

Conclusions:

• Discordant benign results are rare but carry a meaningful risk of malignancy, necessitating prompt diagnostic resolution.
• Standardized definitions, uniform denominators, and prospective multicenter designs are needed to improve comparability and management.
• Structured radiologic-pathologic correlation and timely repeat sampling or excision are vital for patient care.