{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T12:54:07Z","timestamp":1791032047104,"version":"4.1.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the performance of radiologists\u2019 radiologic-pathologic (rad-path) assessment in BI-RADS 4C and 5 breast lesions with benign core biopsy pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Institutional pathology records were reviewed, analyzing surgical excision results for benign core biopsies after BI-RADS 4C and 5 assessments from 2019 to 2024, and the rad-path correlation issued by the radiologist prior to excision was recorded. Pathologic diagnoses and imaging data were retrieved from the electronic medical record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 523 BI-RADS 4C and 5 core biopsies were identified during the study period. The malignancy rate following BI-RADS 4C assessment was 74.1% and following BI-RADS 5 assessment was 93.2%. Fifty-one benign image-guided biopsies underwent radiology-pathology correlation analysis. Radiologists categorized 19\/51 benign pathology results as radiology-pathology discordant, with an upgrade rate to malignancy of 47.3%, and 32\/51 as concordant, with an upgrade rate of 9.4%. All concordant upgrades occurred in high-risk lesions (atypical ductal hyperplasia, papilloma) for which excision had been recommended at the time of concordance assessment. Discordant benign pathology upgraded to malignancy included diagnoses such as dense stromal fibrosis, fibrocystic change, chronic inflammation, atypical ductal hyperplasia, hematoma, and papilloma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Radiologist-performed rad-path correlation is highly reliable for benign BI-RADS 4C and 5 lesions. Radiology-pathology discordant benign biopsies carry a high risk of malignancy and warrant surgical excision. In contrast, radiology-pathology concordant benign results are highly predictive of final benign outcome, particularly when high-risk features are absent. These findings support the essential role of radiologist rad-path correlation in reducing unnecessary surgery and avoiding missed cancers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jbi\/wbag019","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T11:27:49Z","timestamp":1776166069000},"page":"540-549","source":"Crossref","is-referenced-by-count":0,"title":["Institutional Review of BI-RADS 5 and BI-RADS 4C Lesions Over 5 Years Following Surgical Excision: Analysis of Radiology-Pathology Correlation"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7207-4809","authenticated-orcid":false,"given":"Jennie E","family":"Brodsky","sequence":"first","affiliation":[{"name":"Department of Radiology, Washington University in St. Louis , St Louis, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Ly","sequence":"additional","affiliation":[{"name":"Department of Radiology, Washington University in St. Louis , St Louis, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Washington , Seattle, WA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian S","family":"Hagemann","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology, Washington University in St. Louis , St Louis, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3733-893X","authenticated-orcid":false,"given":"Michelle V","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Washington University in St. Louis , St Louis, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"issue":"2","key":"2026100308214905700_wbag019-B1","doi-asserted-by":"publisher","first-page":"341","DOI":"10.2214\/ajr.166.2.8553943","article-title":"Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy","volume":"166","author":"Brenner","year":"1996","journal-title":"AJR Am J Roentgenol"},{"issue":"5","key":"2026100308214905700_wbag019-B2","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.2214\/ajr.174.5.1741191","article-title":"Percutaneous imaging-guided core breast biopsy: state of the art at the millennium","volume":"174","author":"Liberman","year":"2000","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"2026100308214905700_wbag019-B3","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.3349\/ymj.2012.53.6.1203","article-title":"Koo JS Histological analysis of benign breast imaging reporting and data system categories 4c and 5 breast lesions in imaging study","volume":"53","author":"Kim","year":"2012","journal-title":"Yonsei Med J"},{"issue":"8","key":"2026100308214905700_wbag019-B4","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1016\/j.acra.2018.07.018","article-title":"BI-RADS Category 5 Assessments at Diagnostic Breast Imaging:Outcomes Analysis Based on Lesion Descriptors","volume":"26","author":"Yao","year":"2019","journal-title":"Acad Radiol"},{"key":"2026100308214905700_wbag019-B5","first-page":"1","volume-title":"ACR BI-RADS Atlas, Breast Imaging Reporting and Data System","author":"Mendelson","year":"2013","edition":"5th ed"},{"issue":"5","key":"2026100308214905700_wbag019-B6","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.2214\/AJR.07.3259","article-title":"Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography","volume":"190","author":"Kim","year":"2008","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"2026100308214905700_wbag019-B7","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1148\/radiol.2392042127","article-title":"BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value","volume":"239","author":"Lazarus","year":"2006","journal-title":"Radiology"},{"issue":"2","key":"2026100308214905700_wbag019-B8","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ejrad.2007.04.008","article-title":"Observer variability of Breast Imaging Reporting and Data System (BI-RADS) for breast ultrasound","volume":"65","author":"Lee","year":"2008","journal-title":"Eur J Radiol"},{"issue":"2","key":"2026100308214905700_wbag019-B9","doi-asserted-by":"publisher","first-page":"232","DOI":"10.3348\/kjr.2011.12.2.232","article-title":"Concordant or discordant? 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