Management of Elevated Risk (high-risk) Breast Lesions (2026)-R4-CBR0922-2026

Video Transcription

Video Summary

The transcript reviews breast “high-risk” lesions from pathology, UK/European, and U.S. perspectives. It explains that risk has two meanings: the chance a lesion predicts future breast cancer, and the chance a biopsy has under-sampled a more serious lesion nearby. Pathology categories range from nonproliferative changes, which do not raise risk, to proliferative disease, proliferative disease with atypia (ADH, ALH), and carcinoma in situ, especially LCIS, which carries the highest future risk.<br /><br />Key lesions discussed include flat epithelial atypia, complex sclerosing lesions/radial scars, atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, fibroepithelial lesions, and papillomas. For each, the speakers describe histologic features, common diagnostic pitfalls, and whether excision or surveillance is recommended. Good radiology-pathology correlation is emphasized throughout, because upgrade rates to DCIS or invasive cancer drop sharply when imaging and pathology are concordant and the suspicious target is adequately sampled or removed.<br /><br />The UK speaker highlights national guidelines favoring vacuum-assisted excision to reduce unnecessary surgery while still detecting hidden cancer. The American speaker emphasizes the lack of a national system, the importance of MQSA/BI-RADS audit standards, and evolving practice toward surveillance for concordant lobular neoplasia, while ADH still often goes to excision. Overall, the central message is to avoid overtreatment while not missing occult cancer.

Keywords

breast high-risk lesions

pathology

atypical ductal hyperplasia

atypical lobular hyperplasia

lobular carcinoma in situ

radiology-pathology correlation

vacuum-assisted excision

BI-RADS

occult breast cancer