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Review
. 2025 May;35(5):2397-2411.
doi: 10.1007/s00330-024-11133-4. Epub 2024 Nov 15.

Misdiagnosis in breast imaging: a statement paper from European Society Breast Imaging (EUSOBI)-Part 2: Main causes of errors in breast imaging and recommendations from European Society of Breast Imaging to limit misdiagnosis

Isabelle Thomassin-Naggara  1   2 , Alexandra Athanasiou  3 , Fleur Kilburn-Toppin  4 , Gabor Forrai  5 , Miruna Ispas  6 , Mihai Lesaru  6 , Elisabetta Giannotti  3 , Katja Pinker-Domenig  7   8 , Chantal Van Ongeval  9 , Ritse M Mann  10   11 , Fiona Gilbert  4 , Federica Pediconi  12 ; EUSOBI Board
Collaborators, Affiliations
Review

Misdiagnosis in breast imaging: a statement paper from European Society Breast Imaging (EUSOBI)-Part 2: Main causes of errors in breast imaging and recommendations from European Society of Breast Imaging to limit misdiagnosis

Isabelle Thomassin-Naggara et al. Eur Radiol. 2025 May.

Abstract

Importance: Breast cancer is one of the leading causes of negligence claims in radiology. The objective of this document is to describe the specific main causes of errors in breast imaging and provide European Society of Breast Imaging (EUSOBI) recommendations to try to minimize these.

Observations: Technical failures represent 17% of all mammographic diagnostic negligence claims. Mammography quality control protocol and dedicated training for technologists and radiologists are essential. Lack of consideration of the clinical context is a second critical issue, as a clinical abnormality is found in 80% of malpractice claims. EUSOBI emphasizes the importance of communication and clinical examination before the diagnostic investigation. Detection errors or misapplications of the lexicon or Breast Imaging Reporting Data System (BI-RADS) score account for 5% of malpractice claims and should be reduced by limiting radiologists' distraction or fatigue, and being aware of satisfaction of search errors and the importance of a personal systematic review. Errors related to pathological concordance and MDT review can be limited by the use of markers after biopsy and the use of standardized reports, which can aid communication with other specialities. Finally, errors related to tumor or patient factors should be discussed, considering the use of contrast-enhanced mammography and magnetic resonance imaging.

Conclusion: Several factors are responsible for misdiagnosis in breast cancer, including errors in the practice of the technician and/or radiologist (technical failures, lack of consideration of the clinical context, incorrect application of the BI-RADS score, false reassurances), lack of communication with other specialists or with the patient, and the type of tumor and breast parenchyma.

Key points: Question What factors most contribute to and what implications stem from misdiagnosis in breast imaging? Findings Ongoing training and education for radiologists and other healthcare providers, as well as interdisciplinary collaboration and communication is paramount. Clinical relevance Misdiagnosis in breast imaging can have significant implications for patients, healthcare providers, and the entire healthcare system.

Keywords: Breast cancer; MRI; Mammography; Misdiagnosis; Ultrasonography.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Isabelle Thomassin-Naggara. Conflict of interest: The authors declare the following disclosure: Isabelle Thomassin-Naggara: speakers bureaus—European Society of Breast Imaging (active), Société d’imagerie de la femme (active), Amercian College of Radiology O-RADS (active), Bayer (ended), Siemens Healthineers (ended), Guerbet (ended), Bard (ended); Ponctual remunerated lectures—GE, Siemens, Guerbet, Hologic, Canon, Guebet, Bracco, GSD, Samsung, Fujifilm, Incepto, ICAD; Research grants—ASCORDIA: ADNEX MR Scoring System: Impact of an MR scoring system on therapeutic strategy of pelvic adnexal masses PHRC ID RCB 2015-A01593-46. Katia Pinker-Domenig: speakers bureaus—European Society of Breast Imaging (active), Bayer (ended), Siemens Healthineers (ended), DKD 2019 (ended), Olea Medical (ended), Roche (ended), MedScape (ended). Consulting, Advisory: Consultant—Genentech, Inc., 05/19–present (non-monetary); Consultant—Merantix Healthcare, 05/20–1/2014; Consultant—AURA Health Technologies GmbH, 04/21–2/24; Consultant—Guerbet, 05/2023–1/2024; Consultant—Neodynamics, 12/20223–present. Research grants: Digital Hybrid Breast PET/MRI for Enhanced Diagnosis of Breast Cancer (HYPMED) H2020—Research and Innovation Framework Program PHC-11-2015 # 667211-2; A Body Scan for Cancer Detection using Quantum Technology (CANCERSCAN) H2020-FETOPEN # 828978; Multiparametric 18F-Fluoroestradiol PET/MRI coupled with Radiomics Analysis and Machine Learning for Prediction and Assessment of Response to Neoadjuvant Endocrine Therapy in Patients with Hormone Receptor +/HER2 − Invasive Breast Cancer Jubiläumsfonds of the Austrian National Bank # Nr: 18207; Deciphering breast cancer heterogeneity and tackling the hypoxic tumor microenvironment challenge with PET/MRI, MSI and radiomics The Vienna Science and Technology Fund LS19-046; MSKCC 2020 Molecularly Targeted Intra-Operative Imaging Award 07/2020–06/2021; Breast Cancer Research Foundation 06/2019–05/2021; NIH R01 Breast Cancer Intravoxel-Incoherent-Motion MRI Multisite (BRIMM) 09/01/2020–08/30/2025 UG3 CA239861; NIH R01 subaward: Abbreviated Non-Contrast-Enhanced MRI for Breast Cancer Screening 09/01/2023–08/31/2025 R01 CA249893; NIH RO1: Deciphering the Acidic Tumor Environment: A Phase I/IIa Study of Pre-Operative Multiparametric MRI and pHLIP® ICG Intra-Operative Fluorescence Imaging of Primary Breast Cancer 03/01/2023-02/29/2024 1R01CA270018-01A1. Katja Pinker is supported in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. All other authors have nothing to disclose directly related to the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was not required for this study. Ethical approval: Institutional Review Board approval was not required. Study subjects or cohorts overlap: Not applicable. Methodology: Review

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