Management of High-Risk Breast Lesions

Abstract

Breast lesions with certain types of “benign” pathology on core breast biopsy pose a management dilemma. Although the lesion is not considered malignant by core biopsy, specific benign pathologies can be upgraded to carcinoma after surgical excision. These benign pathologies include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, papillary lesions, and radial scar. Core biopsy of these lesions can underestimate malignancy; therefore, these lesions are regarded as nonmalignant but high risk. The literature is controversial regarding the appropriate treatment of patients who have nonmalignant but high-risk diagnoses, especially for less commonly encountered pathologies. The core biopsy medical literature comprises, for the most part, single-institution retrospective reviews with insufficient numbers of these uncommon high-risk lesions to provide meaningful practice guidance. The authors reviewed the current medical literature from January 1999 through December 2009 in American Journal of Roentgenology (AJR) and Radiology discussing core-needle biopsy of these lesions in an attempt to determine the feasibility of developing a comprehensive management strategy of these high-risk but nonmalignant lesions.