Evidence-Based Pragmatic Approach to the Management of Borderline or High-Risk Breast Lesions

The management of borderline or high-risk breast lesions (HRLs) remains controversial. We propose a pragmatic evidence-based approach based on lesion type. For lobular carcinoma in situ with pleomorphism, papilloma with atypia, atypical ductal hyperplasia, and fibroepithelial lesions, surgical consultation and excision are recommended. Patients with other borderline or HRLs are referred for surgical consultation to discuss excision versus surveillance. Our recommendations align with American Society of Breast Surgeons guidelines, which aim to reduce unnecessary surgery and ensure appropriate follow-up.