High-Risk Breast Lesions on Core Biopsy: Rates of Upgrade and Management Recommendations

High-risk lesions of the breast confer an increased risk for breast cancer. Due to wide variations in the reported rate of upgrade to carcinoma at excision, optimal management of these lesions is controversial. Intraductal papillomas, mucocele-like lesions, radial scars, and complex sclerosing lesions without atypia found on core biopsy do not require excision. Flat epithelial atypia and classic lobular neoplasia can be managed conservatively while nonclassic forms of lobular carcinoma in situ should undergo excision. In most cases, atypical ductal hyperplasia should be surgically excised, though there is a subset of patients for whom nonsurgical management can be considered.