Long-term follow-up confirms patients with high-risk breast lesions can be successfully managed at a...

The management of high-risk breast lesions is controversial. There is a lack of long-term follow-up studies to evaluate clinical management decisions.

We included 267 consecutive high-risk breast lesions with pathology-radiology concordance that were prospectively recommended for surgery or follow-up at a multidisciplinary conference. The 267 lesions included 149 papillomas and 118 other high-risk lesions. The 149 papillomas included 119 benign papillomas, 17 atypical papillomas, 6 papillomas with adjacent atypical ductal hyperplasia (ADH), 7 papillomas with adjacent atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS). The 118 high-risk lesions included 43 ADH, 36 radial scar (RS), 23 ALH, 13 LCIS, 2 flat epithelial atypia (FEA), and 1 mucocele-like lesion (ML). The patients were recommended for surgery or follow-up using established guidelines.

90 (60.4%) patients with papillomas, who did not undergo immediate excision and were followed, had a median follow-up time of 61.6 months; 70 patients had a follow-up time > 2 years (25.1-103.4 months). Two patients (2.1%) with benign papilloma had history of breast cancer and developed carcinoma in 62.7 at the lumpectomy site and 40.8 months at the biopsy site which showed 2 mm benign papilloma; both papillomas were sufficiently sampled, and we believe the recommendation of follow-up to both patients was appropriate. 65 (55.1%) patients with other high-risk lesions, who did not undergo excision and were followed, had a median follow-up time of 64.1 months; 50 patients had a follow-up time > 2 years (24.2-101.6 months). Four (6.2%) of these 65 patients developed carcinoma during follow-up including 2 patients with ADH who were recommended for surgery but chose for follow-up; 1 patient with ALH developed invasive carcinoma in a different quadrant at 76.6 months; and 1 patient with RS developed invasive carcinoma in the same quadrant at 51.2 months. In the 112 patients who underwent immediate excision, all upgrades (n = 15) occurred in patients who were recommended for surgery. During follow-up of these 112 patients, 2 patients developed carcinoma and both had benign pathology in the excisional specimens.

This long-term follow-up study confirms that a multidisciplinary conference can successfully triage patients with high-risk breast lesions to surgery or follow-up with established guidelines and careful pathology, radiology, and clinical evaluations. Patients with high-risk breast lesions have increased cancer risk and should be followed.