Factors affecting the concordance of radiologic and pathologic tumor size in breast carcinoma

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. 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. 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). 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