Original ArticlesChanges in the Diagnoses of Breast Core Needle Biopsies on Second Review at a Tertiary Care Center Implications for Surgical ManagementCalle, Catarina MD*,†; Zhong, Elaine MD*; Hanna, Matthew G. MD*; Ventura, Katia BS*; Friedlander, Maria A. CT(ASCP)*; Morrow, Monica MD‡; Cody, Hiram III MD‡; Brogi, Edi MD, PhD* Author Information Departments of *Pathology ‡Surgery, Memorial Sloan Kettering Cancer Center, New York, NY †Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal C.C. and E.Z. contributed equally. E.B. devised the project. C.C., E.Z., M.G.H., K.V., and M.A.F. collected data. M.M. and H.C. provided critical feedback; C.C. and E.Z. wrote the manuscript in consultation with E.B. and with input from all authors. Conflicts of Interest and Source of Funding: Supported in part by a Cancer Center Support Grant of the National Institute of Health/National Cancer Institute (grant number P30CA008748). M.G.H. is a consultant of PaigeAI and advisor of PathPresenter. M.M. has received honoraria from Roche and Exact Sciences. For the remaining authors none were declared. Correspondence: Edi Brogi, MD, PhD, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (e-mail: [email protected]). Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.ajsp.com. The American Journal of Surgical Pathology 47(2):p 172-182, February 2023. | DOI: 10.1097/PAS.0000000000002002 Buy SDC Metrics Abstract Core needle biopsy (CNB) of breast lesions is routine for diagnosis and treatment planning. Despite refinement of diagnostic criteria, the diagnosis of breast lesions on CNB can be challenging. At many centers, including ours, confirmation of diagnoses rendered in other laboratories is required before treatment planning. We identified CNBs first diagnosed elsewhere that were reviewed in our department over the course of 1 year because the patients sought care at our center and in which a change in diagnosis had been recorded. The outside and in-house CNB diagnoses were then classified based on Breast WHO Fifth Edition diagnostic categories. The impact of the change in diagnosis was estimated based on the subsequent surgical management. Findings in follow-up surgical excisions (EXCs) were used for validation. In 2018, 4950 outside cases with CNB were reviewed at our center. A total of 403 CNBs diagnoses were discrepant. Of these, 147 had a change in the WHO diagnostic category: 80 (54%) CNBs had a more severe diagnosis and 44 (30%) a less severe diagnosis. In 23 (16%) CNBs, the change of diagnostic category had no impact on management. Intraductal proliferations (n=54), microinvasive carcinoma (n=18), and papillary lesions (n=35) were the most disputed diagnoses. The in-house CNB diagnosis was confirmed in most cases with available excisions. Following CNB reclassification, 22/147 (15%) lesions were not excised. A change affecting the surgical management at our center occurred in 2.5% of all CNBs. Our results support routine review of outside breast CNB as a clinically significant practice before definitive treatment. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.