Preventing missed malignancies: impact of standardized radiology-pathology concordance assessment in CT-guided omental and mesenteric biopsies.

OBJECTIVE

To analyze outcomes of non-malignant concordant, discordant, and indeterminate results of CT-guided biopsies determined by standardized radiology-pathology concordance evaluation.

METHODS

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.

DEFINITIONS

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.

RESULTS

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.

CONCLUSION

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.