Rad-Path Correlate: Concordance and Discordance Rates in Danbury Hospital Patient Population

Abstract

Abstract Objectives Imaging-guided needle biopsy is a reliable alternative to surgical biopsy in the diagnosis of breast pathologies. However, false-positive results are common. Rad-Path correlation is crucial in identifying such results, thus allowing appropriate diagnosis and follow-up. We report our experience of Rad-Path correlation results in a community teaching hospital. Methods The tumor board data at Danbury Hospital were searched for Rad-Path conferences held from 2013 to 2018. Benign breast biopsies obtained from SNOMED, a monthly pathology list of imaging-guided needle biopsies performed at Danbury Hospital, were presented at these conferences. Data from the list were used for this research. Fibroadenoma cases were excluded in the analysis. The total number of cases presented and proportion of concordant and discordant cases were reviewed. Data on discordant cases were further reviewed to determine the reasons for discordance and follow-up outcomes. Results In the last 6 years, 64 Rad-Path meetings were held. A total of 393 benign breast biopsies were presented. Of the 393 cases, 24 (6.1%) were discordant. The radiologic findings for the discordant cases were as follows: mass/nodule, 15; calcifications, 7; linear nonmass enhancement, 1; and duct debris, 1. All the suspicious radiologic findings received a benign pathologic diagnosis. These discrepancies in Rad-Path findings were discussed in detail during the multidisciplinary tumor board. Out of 24 discordant cases, 5 (20.8%) were reviewed by the sign-out radiologist and their BI-RADS updated accordingly, another 5 (20.8%) cases had excisional biopsies, 9 (37.5%) cases were recommended for 6- or 12-month radiology follow-up, and the remaining 5 (20.8%) cases were lost to follow-up. Conclusion Rad-Path correlation is a key component of imaging-guided breast biopsy reporting. It facilitates detection of discordant radiologic and pathologic findings, and it prevents misdiagnosis and unnecessary repeat interventional procedures. This practice ultimately results in improved patient management.