[Benign proliferative breast disease with and without atypia]

Area of Science:

• Breast pathology diagnostics
• High-risk breast lesion management
• Percutaneous biopsy interpretation

Context:

• Increased diagnosis of high-risk breast lesions (ADH, FEA, ALH, LCIS, RS, MLL) due to percutaneous biopsies.
• Management decisions are influenced by cancer risk and potential for malignant transformation.
• Literature review indicates Grade C recommendations for these lesions.

Purpose:

• To review current literature and provide recommendations for the management and follow-up of various high-risk breast lesions.
• To clarify surgical versus non-surgical approaches based on histopathological and radiological findings.
• To guide clinical practice for incidental findings and non-in-sano resections.

Summary:

• Surgical excision is recommended for ADH, FEA, ALH, LCIS, RS, and MLL with atypia.
• Surgical abstention is a valid alternative for FEA or RS without atypia if completely removed via vacuum-assisted biopsy.
• Concordance of radiology and histopathology is crucial for UDH, adenosis, and MLL without atypia; surgery is not recommended.
• Specific follow-up is advised for prior ADH, ALH, LCIS, and lesions with atypia where data is limited.

Impact:

• Provides evidence-based guidance for clinicians managing high-risk breast lesions.
• Aims to optimize patient care by differentiating between lesions requiring surgery and those managed conservatively.
• Highlights areas where further research is needed, particularly for lesions with atypia and specific subtypes.