Sari Lutfullah, Rigiroli Francesca, Brook Alexander, Berkowitz Seth J, Nougaret Stéphanie, Brook Olga R
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, United States.
PINKCC Lab, Institute of Cancer Research of Montpellier, Montpellier, France.
Abdom Radiol (NY). 2025 Sep 13. doi: 10.1007/s00261-025-05183-5.
To analyze outcomes of non-malignant concordant, discordant, and indeterminate results of CT-guided biopsies determined by standardized radiology-pathology concordance evaluation.
In this study, consecutive patients undergoing CT-guided omental and mesenteric biopsy between March 2005 and August 2021 were included. A standardized radiology-pathology concordance workflow was implemented in July 2016, with retrospective concordance assessment applied to earlier cases. Concordance between pathology results and imaging findings was assessed by procedural radiologists.
concordant, for malignant biopsy results or benign pathology where imaging findings agree; discordant, if pathology results are not congruent with imaging; and indeterminate, if imaging could be explained by pathology, but could also represent malignancy.
222 biopsies were included. Pathology showed non-malignant results in 43/222 (19%), further classified by radiology-pathology concordance evaluation as discordant in 24/43 (56%), indeterminate in 8/43 (19%), and concordant in 11/43 (26%). One patient was lost to follow-up in the indeterminate category. The prevalence of malignancy on follow-up was higher in discordant (13/24, 54%) and indeterminate (2/7, 29%) groups vs. concordant cases (0/11, 0%), p < 0.001. There were 15/42 (36%) patients with final diagnosis of malignancy that would have been missed if radiology-pathology concordance evaluation had not been performed. Median time to diagnosis was shorter with repeat biopsy (18 days, IQR 9-34) and surgery (41 days, IQR 17-60) vs. imaging (185 days, IQR 107-239) and clinical follow-up (330 days, IQR 240-374), p < 0.001.
Radiology-pathology concordance evaluation in CT-guided omental and mesenteric biopsies showed high malignancy rates in initially non-malignant discordant (54%) and indeterminate (29%) cases. This practice prevented missed cancer diagnoses in 36% of patients with initial non-malignant results.
通过标准化的放射学-病理学一致性评估，分析CT引导下活检的非恶性一致、不一致和不确定结果的情况。
本研究纳入了2005年3月至2021年8月期间连续接受CT引导下网膜和肠系膜活检的患者。2016年7月实施了标准化的放射学-病理学一致性工作流程，并对早期病例进行回顾性一致性评估。由操作放射科医生评估病理结果与影像学表现之间的一致性。
一致，指恶性活检结果或良性病理且影像学表现相符；不一致，指病理结果与影像学不符；不确定，指影像学表现可由病理解释，但也可能代表恶性肿瘤。
共纳入222例活检病例。病理显示43/222（19%）为非恶性结果，根据放射学-病理学一致性评估进一步分类为：24/43（56%）不一致，8/43（19%）不确定，11/43（26%）一致。不确定组中有1例患者失访。随访中，不一致组（13/24，54%）和不确定组（2/7，29%）的恶性肿瘤患病率高于一致组（0/11，0%），p<0.001。若未进行放射学-病理学一致性评估，15/42（36%）最终诊断为恶性肿瘤的患者将会被漏诊。重复活检（18天，四分位间距9-34）和手术（41天，四分位间距17-60）的诊断中位时间短于影像学检查（185天，四分位间距107-239）和临床随访（330天，四分位间距240-374），p<0.001。
CT引导下网膜和肠系膜活检的放射学-病理学一致性评估显示，最初非恶性的不一致（54%）和不确定（29%）病例中恶性肿瘤发生率较高。这种做法避免了36%最初非恶性结果患者的癌症漏诊。
