BIRADS 4 lesion with discordant pathology (ultrasound)
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The spiculated mass seen on the ultrasound was not seen on mammogram. It was palpable and biopsied under ultrasound guidance.
This lesion came back with histology of fibroadenomatous change. The benign pathology was considered discordant with the imaging and re-biopsy confirmed malignant changes.
Pathology review with the imaging is standard of care in breast imaging. This case was apparently due to a processing error following a software installation and upgrade in the path lab.