Management of Elevated Risk (high-risk) Breast Lesions (2022)-R4-CBR09-2022

Video Transcription

Video Summary

The session focused on the pathology and management of high-risk breast lesions, specifically their categorization, diagnosis, and management strategies across different regions. Initially, the presentation outlined the classification of these lesions and their associated risks for developing invasive carcinoma. Nonproliferative changes pose minimal risk, whereas proliferative diseases and those with atypia, like ADH and ALH, markedly increase cancer risk. The discussion also encompassed complex sclerosing lesions, fibroepithelial lesions, and large duct papillomas, each with unique challenges and management protocols.<br /><br />European guidelines emphasize avoiding unnecessary surgery and advocate for vacuum-assisted excision except in specific cases, like papillomas with atypia, contrasting with some international standards recommending surgical excision. The session highlighted the importance of robust multidisciplinary discussions and clear guidelines to avoid over-treatment, ensuring accurate cancer diagnosis preoperatively.<br /><br />From a US perspective, the fragmented healthcare system presents challenges in standardized care, leading to variable practices. However, there's increasing movement towards a more conservative surgical approach for certain lesions, acknowledging ongoing studies and data supporting minimal intervention for low-risk lesions, while continuing to provide adequate surveillance and support for patients with elevated long-term risks.

Keywords

high-risk breast lesions

pathology

management strategies

diagnosis

proliferative diseases

European guidelines

surgical excision

multidisciplinary discussions

conservative surgical approach