Discordance between breast imaging and histopathology findings after ultrasound guided core needle biopsy
Date of Award
Master of Medicine (MMed)
Prof. Sudhir Vinayak
Dr. Rose Ndumia
Dr. Shahin Sayed
Imaging and Diagnostic Radiology (East Africa)
Introduction: Breast cancer is the most prevalent cancer among women worldwide with an estimated global incidence of 11.6%. According to the GLOBOCAN factsheet, in 2018 breast cancer incidence in Kenya was 40.3 per 100,000. Early detection and diagnosis of breast cancer has been shown to reduce mortality and increase years of life gained. Breast lesion diagnosis is heavily based on imaging and pathology and typically findings are reported independent of one another. Correlation of imaging findings and pathology after biopsy is found to be of critical importance in detecting possible sampling error, concordance versus discordance, recommend appropriate management and thus avoid a delay in diagnosis.
Several studies have described the concordance/discordance of breast imaging/pathology findings and the internationally acceptable discordancy rate for breast lesions ranges between 1% and 8%. There are no studies of the level of concordance/discordance between breast imaging and pathology from Africa.
Objectives: The main objective of this study was to determine the prevalence of discordant breast imaging and pathology findings after ultrasound guided breast biopsy.
Methods: This was a cross sectional study with data collected retrospectively. Patients with BI-RADS 3, 4 and 5 breast lesions who had ultrasound guided breast biopsy and histopathology were included in the study. Evaluation for imaging-pathology concordance and discordance was performed. Correlation of discordancy and imaging features such as size of lesion, shape, BI-RADS category, type of lesion, imaging modality and age of patient was also assessed. Follow up outcomes for discordant imaging-pathology results were also obtained where available.
Results: A total of 416 cases were included in this study with an overall imaging-pathology discordancy prevalence of 11.3%. All the 47 discordant cases were discordant benign with no case of discordant malignant. There was significance association of discordancy with BI-RADS category. Three of the 47 (6.4%) discordant cases on follow up showed malignancy.
Conclusion and Recommendation: The 11.3% prevalence of breast imaging-histopathology discordancy was higher compared to similar studies reported in literature which had discordancy rates ranging 1-8%. This together with the upgrade to malignancy of 6.4% of the discordant benign cases emphasizes the importance of timely breast Imaging-histopathology correlation and careful follow-up of discordant cases.
Mwania, M. M. (2020). Discordance between breast imaging and histopathology findings after ultrasound guided core needle biopsy (Unpublished master's dissertation). Aga Khan University, East Africa.