High Risk Breast Lesions

Atypical Ductal Hyperplasia is the most common of the high risk lesions. The growth of cells in the duct is abnormal and some features of ductal carcinoma in situ (DCIS) are present. A surgical excisional biopsy is recommended to check the surrounding areas for anything more worrisome.

Lobular neoplasia includes both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). These are considered markers for increased risk for breast cancer. There are controversial management recommendations regarding surgical excision of these types of high risk lesions.

While not cancerous itself, if flat epithelial atypia is found on your core needle biopsy, a surgical excisional biopsy will be recommended since it is sometimes found near more worrisome conditions.

Since a core needle biopsy only takes a few small samples of tissue to analyze, there are cases where the pathologist cannot determine if the mass is a fibroadenoma or a phyllode tumor. In those cases, fibroepithelial lesion will be the diagnosis on the pathology report and further evaluation will be recommended.

• Fibroadenoma: A fibroadenoma is the most common benign tumor of the breast. These masses are usually firm, “rubbery”, and moveable. While fibroadenoma qualities can be determined on imaging, it is important to have a biopsy to confirm the diagnosis. Most fibroadenomas are not removed unless the patient is symptomatic or the mass grows over time.
• Phyllodes Tumor: Similar in appearance to a fibroadenoma, a phyllodes tumor is a rare mass that grows from the stroma cells, or connective tissue, of the breast. Most phyllodes tumors are benign but, on rare occasions, can be malignant and aggressive. If diagnosed on biopsy, phyllodes tumors are completely excised for further evaluation.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare, benign lesion that usually presents itself as a firm, moveable palpable mass. Usually painless, this mass consists of myofibroblastic cells, which are both connective tissue and smooth muscle cells.

A sclerosing lesion is an area of the breast with hardened tissue. This condition is considered benign or noncancerous. The most common type is a sclerosing adenosis, which is an extra growth of tissue within the breast lobules.

Cysts that appear simple, full of fluid, on ultrasound can be monitored over time and are usually not aspirated unless a patient is symptomatic. Yet, complex cysts, a mix of fluid and solid, are aspirated to rule out malignancy.

Radial scars are rare. They are reported on less than 1% of all biopsies preformed. However, due to the increased association with DCIS and invasive ductal carcinoma, radial scars are usually surgically excised to appropriately evaluate the condition.

Breast calcifications or microcalcifications are mineral deposits that can appear on mammogram imaging. They can be found in the same area of both benign and malignant lesions. When seen without worrisome changes to the breast, calcifications are considered benign and do not increase your risk for breast cancer. If indicated by imaging, calcifications will be recommended for surgical excision to further evaluate the area.