Factors affecting the concordance of radiologic and pathologic tumor size in breast carcinoma. (February 2019)

• Record Type: Journal Article
• Authors: Hamza, Ameer; Khawar, Sidrah; Sakhi, Ramen; Alrajjal, Ahmed; Miller, Shelby; Ibrar, Warda; Edens, Jacob; Salehi, Sajad; Ockner, Daniel
• Is Part Of: Ultrasound. Volume 27:Number 1(2019:Feb.)
• Page Start: 45
• Page End: 54
• Publication Date: 2019-02
• Subjects: Breast carcinoma -- tumor size -- pathologic staging -- breast ultrasound -- concordance; Ultrasonic imaging -- Periodicals; Ultrasonography -- Periodicals; 616.0754305
• DOI: 10.1177/1742271X18804278
• Languages: English
• ISSNs: 1742-271X

Abstract

Background: Radiologic assessment of tumor size is an integral part of the work-up for breast carcinoma. With improved radiologic equipment, surgical decision relies profoundly upon radiologic/clinical stage. We wanted to see the concordance between radiologic and pathologic tumor size to infer how accurate radiologic/clinical staging is. Materials and methods: The surgical pathology and ultrasonography reports of patients with breast carcinoma were reviewed. Data were collected for 406 cases. Concordance was defined as a size difference within ±2 mm. Results: The difference between radiologic and pathologic tumor size was within ±2 mm in 40.4% cases. The mean radiologic size was 1.73 ± 1.06 cm. The mean pathologic size was 1.84 ± 1.24 cm. A paired t -test showed a significant mean difference between radiologic and pathologic measurements (0.12 ± 1.03 cm, p = 0.03). Despite the size difference, stage classification was the same in 59.9% of cases. Radiologic size overestimated stage in 14.5% of cases and underestimated stage in 25.6% of cases. The concordance rate was significantly higher for tumors ≤2 cm (pT1) (51.1%) as compared to those greater than 2 cm (≥pT2) (19.7%) ( p < 0.0001). Significantly more lumpectomy specimens (47.5%) had concordance when compared to mastectomy specimens (29.8%) ( p < 0.0001). Invasive ductal carcinoma had better concordance compared to other tumors ( p = 0.02). Conclusion: Mean pathologic tumor size was significantly different from mean radiologic tumor size. Concordance was in just over 40% of cases and the stage classification was the same in about 60% of cases only. Therefore, surgical decision of lumpectomy versus mastectomy based on radiologic tumor size may not always be accurate.