Radiologist rad-path correlation highly reliable for benign BI-RADS 4C and 5 breast biopsies

In a 5-year review of BI-RADS 4C and 5 lesions, radiologist-determined radiology-pathology (rad-path) discordance carried a 47.3% upgrade to malignancy versus 9.4% for concordant benign biopsies, supporting its role in guiding surgical excision.

• The study reviewed 523 BI-RADS 4C and 5 core biopsies; the malignancy rate was 74.1% for 4C lesions and 93.2% for 5 lesions.
• Among 51 benign biopsies analyzed, radiologists classified 19 as rad-path discordant and 32 as concordant.
• All upgrades in the concordant group occurred in high-risk lesions (e.g., atypical ductal hyperplasia, papilloma) for which excision had been recommended.

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