Diagnostic Challenges in Breast Needle Core Biopsies, Radiologic-Pathologic Concordance and Pearls

Description

This workshop will be provided by three subspecialized breast pathologists. Breast needle core biopsy is the procedure of choice for targeting palpable and nonpalpable breast lesions including clusters of microcalcifications, spiculated masses, focal asymmetries, areas with architectural distortion and cystic lesions. Breast biopsies are based on and guided by abnormal imaging findings. Concordance is present when pathology findings provide an explanation for the imaging features.Pathologists are integral members of a multidisciplinary team and being involved in determining rad/path concordance is necessary.Several quality assurance studies have shown that active involvement of pathologists in correlating path findings to radiologic features is considered good clinical practice for providing better patient care.

This workshop will provide an introduction to imaging including the different imaging modalities used and their indications, it will also discuss the Breast Imaging Reporting and Data system categories, the BIRADS system used by radiologists in reporting imaging findings. It will also present the different types of biopsies used including the advantages and disadvantages of each. How to handle breast core biopsies in the lab including patient safety and quality assurance measures will be highlighted. The role of the pathologists in assessing biopsies performed for microcalcifications and for masses will be discussed.

For each category, multiple cases and imaging findings will be presented, the radiologic-pathologic concordance and its importance in everyday practice will be discussed. Besides highlighting the importance of radiologic/pathologic concordance, the most common problems encountered when assessing small amount of material on core biopsy and the limitations of core biopsy in certain entities will be highlighted.

Among the histologic entities that will be presented lobular neoplasia, flat epithelial atypia/ADH, ductal carcinoma in situ (DCIS), fibroepithelial lesions, several variants of invasive carcinoma among others.

The workshop will be divided into multiple talks including:

1. Introduction to imaging: will discuss the different imaging modalities and the indications for each and will also discuss the BIRADS categories.
2. Different types of biopsies and the advantages and disadvantage of each.
3. Handling core needle biopsies in the histology laboratory: this talk will focus on handling breast biopsies in the lab and patient safety and quality assurance procedures.
4. The role of the pathologists in assessing biopsies performed for microcalcifications: in this talk, several examples of core needle biopsies performed for benign and malignant microcalifications will be presented. For each case, the imaging features will be presented plus the histologic finding. The radiologic/pathologic concordance for each case presented will be discussed.
5. The role of the pathologists in assessing mass lesions (benign and malignant): for this talk, imaging findings for both benign and malignant masses will be presented. For each case the radiologic findings and the histologic findings will be presented. The radiologic/pathologic concordance for each case will be discussed.