Management of High-Risk Breast Lesions: A Comprehensive Update

Area of Science:

• Breast pathology and oncology
• Radiology and medical imaging
• Surgical management of breast disease

Background:

• High-risk breast lesions (HRLs) present diagnostic and management challenges due to their association with malignancy or increased future cancer risk.
• Current management strategies for HRLs are inconsistent, necessitating standardized, evidence-based guidelines.
• Multidisciplinary collaboration is crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To review current literature and guidance on the histopathologic features, imaging, and management of various HRLs.
• To provide context for developing unified, evidence-based guidelines for HRL management.
• To highlight the role of multidisciplinary discussion in personalized breast cancer care.

Main Methods:

• Comprehensive literature review of existing studies and current clinical guidance on HRLs.
• Analysis of histopathologic and imaging characteristics of specific HRLs.
• Synthesis of management strategies, including surgical and nonoperative approaches.

Main Results:

• Nonoperative management is supported for select radiologic-pathologic concordant lesions (e.g., limited atypical ductal hyperplasia, pure flat epithelial atypia, pure radial scar).
• Excision remains indicated for lesions with higher upgrade rates, such as lobular carcinoma in situ subtypes, papilloma with atypia, and mucocele-like lesions with atypia.
• HRLs serve as biomarkers for long-term breast cancer risk, influencing surveillance and chemoprevention recommendations.

Conclusions:

• Achieving consensus among radiology, pathology, and surgery is essential for safe and effective HRL management.
• Personalized care, informed by multidisciplinary discussion, is key to minimizing overtreatment while ensuring oncologic safety.
• Standardized guidelines will improve consistency in managing HRLs, impacting future breast cancer risk assessment and patient counseling.