Management of the high-risk breast lesion

Abstract

The clinical management of high-risk breast lesions is intellectually challenging, continually evolving over time and occasionally controversial. The evaluation of all breast conditions begins with a thorough history and physical exam, appropriate breast imaging, and cytologic or histologic evaluation when indicated. Percutaneous core needle biopsy (CNB) has become the diagnostic modality of choice for both palpable and non-palpable breast lesions when histologic assessment is desired. In the treatment of breast cancer, preoperative diagnosis by CNB offers many advantages over open surgical biopsy. CNB provides preoperative clinical staging and tumor marker assessment, enables discussion of neoadjuvant options, and increases the rate of breast-conserving therapy. Yet, the majority of image-detected breast lesions are benign, and most patients who undergo a breast biopsy will not have a diagnosis of malignancy. When there is concordance among clinical history, physical examination, imaging, and needle biopsy pathology, CNB may obviate the need for surgery to prevent under- and overtreatment of patients. However, some CNB findings are considered “borderline” because the CNB reveals a nonmalignant diagnosis, but cancer might be present at the biopsy site, implying a sampling error.