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Radiology pathology.

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Correlation is an important part of doing breast procedures,

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and this should be performed

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by the radiologist who did the procedure.

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The diagnosis must make sense in terms

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of the imaging appearance.

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If the results are discordant, meaning they don't make sense

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with the imaging appearance, we may need to repeat a biopsy,

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maybe use a different modality for guidance

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or potentially excise that part of the breast.

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If there are any questions, reach out to your pathologist.

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Um, go over what the diagnosis is.

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Do they think a radial scar in a biopsy for calcifications

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is related or is it incidental?

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There are lots of incidental findings

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that don't necessarily need to be addressed

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if the biopsy was for calcifications.

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It's important to note whether

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or not calcifications were in the specimen radiograph

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for evaluation of concordance.

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There are some times where we target calcifications

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and we may take a second sample after retargeting,

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but we still don't get the calcifications.

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It's hard to say a benign pathology result is concordant.

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If you haven't gotten the calcifications.

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On the flip side, if you haven't gotten the calcifications,

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but your diagnosis is cancer, then

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you don't need to repeat the biopsy.

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There are cases of Noncalcified DCIS.

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We know that the extent of disease is larger than the

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mammographic uh, representation.

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So in a positive case, um, it may be acceptable not

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to have seen the calcifications in the specimen radiograph.

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The pathologist should comment on the presence

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or absence of calcifications if calcification was

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the target of the biopsy.

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If the specimen contains, uh, both benign

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and malignant processes, I want the pathologist

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to tell me which process is associated

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with the target calcifications.

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For example, if the specimen has both fibrocystic change

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and DCIS

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and the biopsy was rec calcifications,

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if the calcifications are associated

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with the fibrocystic change,

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even if there are residual calcifications,

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they may not all need to be excised, um,

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because that's a benign process for

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noncalcified targets.

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Um, your pretest probability of cancer

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is really important

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because we don't have the specimen radiograph

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to establish satisfactory sampling.

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The clip location on the post biopsy mammogram, uh,

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will help you determine whether

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or not you biopsy the right, uh, location in the breast.

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And for these,

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Uh, targets, I find that

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tomosynthesis on the post biopsy imaging can be very helpful

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for evaluating the presence

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or absence of really a minute residual lesion

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or calcifications.

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In these patients with noncalcified targets,

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a post biopsy hematoma may obscure your underlying target.

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And so if the diagnosis is, uh, benign breast tissue

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and you targeted a mass, it may be useful

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to have the patient come back in a couple of weeks

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to make sure the clip is in the right location

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after the post biopsy changes resolve

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and some, uh, findings,

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even if the pathology is discordant,

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may still require excision.

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For example, a large area

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of architectural distortion if radial scar is found on the

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pathology, if it's a large area,

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they still may need excision.

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So post biopsy mammogram is important to show whether

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or not the clip is in the right spot.