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Imaging-Histopathologic Discordance
Wendie A. Berg, MD, PhD, FACR, FSBI; Marion E. Scoggins, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Histopathologic findings from percutaneous breast biopsy do not provide acceptable explanation for imaging features

          IMAGING

          • General Features

            • Mammographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Image-Guided Biopsy

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Davidson T et al: Correlations between core needle biopsy and excisional biopsy findings in suspected breast lesions: a single center study. Isr Med Assoc J. 20(7):401-4, 2018
                                  2. Jung I et al: Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience. Ultrasonography. 37(1):55-62, 2018
                                  3. Maldonado S et al: Utility of short-interval follow-up mammography after a benign-concordant stereotactic breast biopsy result. Breast. 42:50-3, 2018
                                  4. Park VY et al: Evaluating imaging-pathology concordance and discordance after ultrasound-guided breast biopsy. Ultrasonography. 37(2):107-20, 2018
                                  5. Santiago L et al: MR imaging-guided breast interventions: indications, key principles, and imaging-pathology correlation. Magn Reson Imaging Clin N Am. 26(2):235-46, 2018
                                  6. Shin K et al: Tomosynthesis-guided core biopsy of the breast: why and how to use it. J Clin Imaging Sci. 8:28, 2018
                                  7. Deb R et al: National survey of B1 and B2 reporting of breast needle core biopsies. J Clin Pathol. 69(3):271-4, 2016
                                  8. Monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
                                  9. Prakash S et al: Improving patient care by incorporation of multidisciplinary breast radiology-pathology correlation conference. Can Assoc Radiol J. 67(2):122-9, 2016
                                  10. Soyder A et al: Imaging-histological discordance after sonographically guided percutaneous breast core biopsy. Breast Care (Basel). 10(1):33-7, 2015
                                  11. Lee SH et al: Vacuum-assisted breast biopsy under ultrasonographic guidance: analysis of a 10-year experience. Ultrasonography. 33(4):259-66, 2014
                                  12. Spick C et al: Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 273(2):401-9, 2014
                                  13. Gümüş H et al: Breast microcalcification: diagnostic value of calcified and non-calcified cores on specimen radiographs. Breast J. 19(2):156-61, 2013
                                  14. Ho CP et al: Interactive case review of radiologic and pathologic findings from breast biopsy: are they concordant? How do I manage the results? Radiographics. 33(4):E149-52, 2013
                                  15. Sung JS et al: Patient follow-up after concordant histologically benign imaging-guided biopsy of MRI-detected lesions. AJR Am J Roentgenol. 198(6):1464-9, 2012
                                  16. Zhang C et al: The negative predictive value of ultrasound-guided 14-gauge core needle biopsy of breast masses: a validation study of 339 cases. Cancer Imaging. 12:488-96, 2012
                                  17. Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 258(2):380-7, 2011
                                  18. Son EJ et al: Imaging-histologic discordance after sonographically guided percutaneous breast biopsy: a prospective observational study. Ultrasound Med Biol. 37(11):1771-8, 2011
                                  19. Wang ZL et al: Breast lesions with imaging-histologic discordance during 16-gauge core needle biopsy system: would vacuum-assisted removal get significantly more definitive histologic diagnosis than vacuum-assisted biopsy? Breast J. 17(5):456-61, 2011
                                  20. Li JL et al: Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy: can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis? Breast. 19(6):446-9, 2010
                                  21. Mihalik JE et al: The rate of imaging-histologic discordance of benign breast disease: a multidisciplinary approach to the management of discordance at a large university-based hospital. Am J Surg. 199(3):319-23; discussion 323, 2010
                                  22. Jackman RJ et al: False-negative diagnoses at stereotactic vacuum-assisted needle breast biopsy: long-term follow-up of 1,280 lesions and review of the literature. AJR Am J Roentgenol. 192(2):341-51, 2009
                                  23. Schueller G et al: Accuracy of ultrasound-guided, large-core needle breast biopsy. Eur Radiol. 18(9):1761-73, 2008
                                  24. Schueller G et al: US-guided 14-gauge core-needle breast biopsy: results of a validation study in 1352 cases. Radiology. 248(2):406-13, 2008
                                  25. Kim MJ et al: Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings. Eur Radiol. 2007 Sep;17(9):2376-83. Epub 2007 Mar 15. Erratum in: Eur Radiol. 17(12):3261, 2007
                                  26. Lee JM et al: Imaging histologic discordance at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 189(4):852-9, 2007
                                  27. Youk JH et al: Missed breast cancers at US-guided core needle biopsy: how to reduce them. Radiographics. 27(1):79-94, 2007
                                  28. Cho N et al: Sonographically guided core biopsy of the breast: comparison of 14-gauge automated gun and 11-gauge directional vacuum-assisted biopsy methods. Korean J Radiol. 6(2):102-9, 2005
                                  29. Crystal P et al: Accuracy of sonographically guided 14-gauge core-needle biopsy: results of 715 consecutive breast biopsies with at least two-year follow-up of benign lesions. J Clin Ultrasound. 33(2):47-52, 2005
                                  30. Dillon MF et al: The accuracy of ultrasound, stereotactic, and clinical core biopsies in the diagnosis of breast cancer, with an analysis of false-negative cases. Ann Surg. 242(5):701-7, 2005
                                  31. Sauer G et al: Ultrasound-guided large-core needle biopsies of breast lesions: analysis of 962 cases to determine the number of samples for reliable tumour classification. Br J Cancer. 92(2):231-5, 2005
                                  32. Crowe JP Jr et al: Does ultrasound core breast biopsy predict histologic finding on excisional biopsy? Am J Surg. 186(4):397-9, 2003
                                  33. Fishman JE et al: US-guided core-needle biopsy of the breast: how many specimens are necessary? Radiology. 226(3):779-82, 2003
                                  34. March DE et al: Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience. Radiology. 227(2):549-55, 2003
                                  35. Philpotts LE et al: Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR Am J Roentgenol. 180(2):347-51, 2003
                                  36. Parker SH et al: Sonographically guided directional vacuum-assisted breast biopsy using a handheld device. AJR Am J Roentgenol. 177(2):405-8, 2001
                                  37. Liberman L et al: Imaging-histologic discordance at percutaneous breast biopsy. Cancer. 89(12):2538-46, 2000
                                  38. Philpotts LE et al: Comparison of rebiopsy rates after stereotactic core needle biopsy of the breast with 11-gauge vacuum suction probe versus 14-gauge needle and automatic gun. AJR Am J Roentgenol. 172(3):683-7, 1999
                                  39. Meyer JE et al: Large-needle core biopsy: nonmalignant breast abnormalities evaluated with surgical excision or repeat core biopsy. Radiology. 206(3):717-20, 1998
                                  40. Berg WA et al: Lessons from mammographic-histopathologic correlation of large-core needle breast biopsy. Radiographics. 16(5):1111-30, 1996
                                  41. Brenner RJ et al: Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy. AJR Am J Roentgenol. 166(2):341-6, 1996
                                  42. Liberman L et al: Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed? Radiology. 192(3):793-5, 1994
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Definitions

                                            • Histopathologic findings from percutaneous breast biopsy do not provide acceptable explanation for imaging features

                                          IMAGING

                                          • General Features

                                            • Mammographic Findings

                                              • Ultrasonographic Findings

                                                • MR Findings

                                                  • Image-Guided Biopsy

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Davidson T et al: Correlations between core needle biopsy and excisional biopsy findings in suspected breast lesions: a single center study. Isr Med Assoc J. 20(7):401-4, 2018
                                                                  2. Jung I et al: Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience. Ultrasonography. 37(1):55-62, 2018
                                                                  3. Maldonado S et al: Utility of short-interval follow-up mammography after a benign-concordant stereotactic breast biopsy result. Breast. 42:50-3, 2018
                                                                  4. Park VY et al: Evaluating imaging-pathology concordance and discordance after ultrasound-guided breast biopsy. Ultrasonography. 37(2):107-20, 2018
                                                                  5. Santiago L et al: MR imaging-guided breast interventions: indications, key principles, and imaging-pathology correlation. Magn Reson Imaging Clin N Am. 26(2):235-46, 2018
                                                                  6. Shin K et al: Tomosynthesis-guided core biopsy of the breast: why and how to use it. J Clin Imaging Sci. 8:28, 2018
                                                                  7. Deb R et al: National survey of B1 and B2 reporting of breast needle core biopsies. J Clin Pathol. 69(3):271-4, 2016
                                                                  8. Monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
                                                                  9. Prakash S et al: Improving patient care by incorporation of multidisciplinary breast radiology-pathology correlation conference. Can Assoc Radiol J. 67(2):122-9, 2016
                                                                  10. Soyder A et al: Imaging-histological discordance after sonographically guided percutaneous breast core biopsy. Breast Care (Basel). 10(1):33-7, 2015
                                                                  11. Lee SH et al: Vacuum-assisted breast biopsy under ultrasonographic guidance: analysis of a 10-year experience. Ultrasonography. 33(4):259-66, 2014
                                                                  12. Spick C et al: Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 273(2):401-9, 2014
                                                                  13. Gümüş H et al: Breast microcalcification: diagnostic value of calcified and non-calcified cores on specimen radiographs. Breast J. 19(2):156-61, 2013
                                                                  14. Ho CP et al: Interactive case review of radiologic and pathologic findings from breast biopsy: are they concordant? How do I manage the results? Radiographics. 33(4):E149-52, 2013
                                                                  15. Sung JS et al: Patient follow-up after concordant histologically benign imaging-guided biopsy of MRI-detected lesions. AJR Am J Roentgenol. 198(6):1464-9, 2012
                                                                  16. Zhang C et al: The negative predictive value of ultrasound-guided 14-gauge core needle biopsy of breast masses: a validation study of 339 cases. Cancer Imaging. 12:488-96, 2012
                                                                  17. Salkowski LR et al: Utility of 6-month follow-up imaging after a concordant benign breast biopsy result. Radiology. 258(2):380-7, 2011
                                                                  18. Son EJ et al: Imaging-histologic discordance after sonographically guided percutaneous breast biopsy: a prospective observational study. Ultrasound Med Biol. 37(11):1771-8, 2011
                                                                  19. Wang ZL et al: Breast lesions with imaging-histologic discordance during 16-gauge core needle biopsy system: would vacuum-assisted removal get significantly more definitive histologic diagnosis than vacuum-assisted biopsy? Breast J. 17(5):456-61, 2011
                                                                  20. Li JL et al: Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy: can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis? Breast. 19(6):446-9, 2010
                                                                  21. Mihalik JE et al: The rate of imaging-histologic discordance of benign breast disease: a multidisciplinary approach to the management of discordance at a large university-based hospital. Am J Surg. 199(3):319-23; discussion 323, 2010
                                                                  22. Jackman RJ et al: False-negative diagnoses at stereotactic vacuum-assisted needle breast biopsy: long-term follow-up of 1,280 lesions and review of the literature. AJR Am J Roentgenol. 192(2):341-51, 2009
                                                                  23. Schueller G et al: Accuracy of ultrasound-guided, large-core needle breast biopsy. Eur Radiol. 18(9):1761-73, 2008
                                                                  24. Schueller G et al: US-guided 14-gauge core-needle breast biopsy: results of a validation study in 1352 cases. Radiology. 248(2):406-13, 2008
                                                                  25. Kim MJ et al: Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings. Eur Radiol. 2007 Sep;17(9):2376-83. Epub 2007 Mar 15. Erratum in: Eur Radiol. 17(12):3261, 2007
                                                                  26. Lee JM et al: Imaging histologic discordance at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 189(4):852-9, 2007
                                                                  27. Youk JH et al: Missed breast cancers at US-guided core needle biopsy: how to reduce them. Radiographics. 27(1):79-94, 2007
                                                                  28. Cho N et al: Sonographically guided core biopsy of the breast: comparison of 14-gauge automated gun and 11-gauge directional vacuum-assisted biopsy methods. Korean J Radiol. 6(2):102-9, 2005
                                                                  29. Crystal P et al: Accuracy of sonographically guided 14-gauge core-needle biopsy: results of 715 consecutive breast biopsies with at least two-year follow-up of benign lesions. J Clin Ultrasound. 33(2):47-52, 2005
                                                                  30. Dillon MF et al: The accuracy of ultrasound, stereotactic, and clinical core biopsies in the diagnosis of breast cancer, with an analysis of false-negative cases. Ann Surg. 242(5):701-7, 2005
                                                                  31. Sauer G et al: Ultrasound-guided large-core needle biopsies of breast lesions: analysis of 962 cases to determine the number of samples for reliable tumour classification. Br J Cancer. 92(2):231-5, 2005
                                                                  32. Crowe JP Jr et al: Does ultrasound core breast biopsy predict histologic finding on excisional biopsy? Am J Surg. 186(4):397-9, 2003
                                                                  33. Fishman JE et al: US-guided core-needle biopsy of the breast: how many specimens are necessary? Radiology. 226(3):779-82, 2003
                                                                  34. March DE et al: Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience. Radiology. 227(2):549-55, 2003
                                                                  35. Philpotts LE et al: Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR Am J Roentgenol. 180(2):347-51, 2003
                                                                  36. Parker SH et al: Sonographically guided directional vacuum-assisted breast biopsy using a handheld device. AJR Am J Roentgenol. 177(2):405-8, 2001
                                                                  37. Liberman L et al: Imaging-histologic discordance at percutaneous breast biopsy. Cancer. 89(12):2538-46, 2000
                                                                  38. Philpotts LE et al: Comparison of rebiopsy rates after stereotactic core needle biopsy of the breast with 11-gauge vacuum suction probe versus 14-gauge needle and automatic gun. AJR Am J Roentgenol. 172(3):683-7, 1999
                                                                  39. Meyer JE et al: Large-needle core biopsy: nonmalignant breast abnormalities evaluated with surgical excision or repeat core biopsy. Radiology. 206(3):717-20, 1998
                                                                  40. Berg WA et al: Lessons from mammographic-histopathologic correlation of large-core needle breast biopsy. Radiographics. 16(5):1111-30, 1996
                                                                  41. Brenner RJ et al: Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy. AJR Am J Roentgenol. 166(2):341-6, 1996
                                                                  42. Liberman L et al: Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed? Radiology. 192(3):793-5, 1994