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Controversies in Pathology

High-risk and selected benign breast lesions diagnosed on core needle biopsy: Evidence for and against immediate surgical excision

Abstract

The vast majority of image-detected breast abnormalities are diagnosed by percutaneous core needle biopsy (CNB) in contemporary practice. For frankly malignant lesions diagnosed by CNB, the standard practice of excision and multimodality therapy have been well-defined. However, for high-risk and selected benign lesions diagnosed by CNB, there is less consensus on optimal patient management and the need for immediate surgical excision. Here we outline the arguments for and against the practice of routine surgical excision of commonly encountered high-risk and selected benign breast lesions diagnosed by CNB. The entities reviewed include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, intraductal papillomas, and radial scars. The data in the peer-reviewed literature confirm the benefits of a patient-centered, multidisciplinary approach that moves away from the reflexive “yes” or “no” for routine excision for a given pathologic diagnosis.

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Fig. 1: Atypical Ductal Hyperplasia (ADH).
Fig. 2: Pleomorphic Lobular Carcinoma in Situ (LCIS).
Fig. 3: Low power view of a Radial Scar from a surgical excision, H&E 20X. H&E shows this benign sclerosing lesion with stellate architecture.
Fig. 4: Images from a Core Needle Biopsy (CNB) of a Radial Scar, all H&E images.
Fig. 5: Images from a Core Needle Biopsy (CNB) of a benign intraductal papilloma.

References

  1. Calhoun BC. Core needle biopsy of the breast: An evaluation of contemporary data. Surg Pathol Clin. 11, 1–16 (2018).

  2. Londero V, Zuiani C, Linda A, Battigelli L, Brondani G, Bazzocchi M. Borderline breast lesions: Comparison of malignancy underestimation rates with 14-gauge core needle biopsy versus 11-gauge vacuum-assisted device. Eur Radiol. 21, 1200–6 (2011).

  3. Miller CL, West JA, Bettini AC, Koerner FC, Gudewicz TM, Freer PE, et al. Surgical excision of radial scars diagnosed by core biopsy may help predict future risk of breast cancer. Breast Cancer Res Treat. 145, 331–8 (2014).

  4. Phantana-Angkool A, Forster MR, Warren YE, Livasy CA, Sobel AH, Beasley LM, et al. Rate of radial scars by core biopsy and upgrading to malignancy or high-risk lesions before and after introduction of digital breast tomosynthesis. Breast Cancer Res Treat. 173, 23–9 (2019).

  5. Rizzo M, Linebarger J, Lowe MC, Pan L, Gabram SG, Vasquez L, et al. Management of papillary breast lesions diagnosed on core-needle biopsy: Clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. J Am Coll Surg. 214, 280–7 (2012).

  6. Glenn ME, Throckmorton AD, Thomison JB, 3rd, Bienkowski RS. Papillomas of the breast 15 mm or smaller: 4-year experience in a community-based dedicated breast imaging clinic. Ann Surg Oncol. 22, 1133–9 (2015).

  7. Nakhlis F. How do we approach benign proliferative lesions? Curr Oncol Rep. 20, 34 (2018).

  8. Georgian-Smith D, Lawton TJ. Variations in physician recommendations for surgery after diagnosis of a high-risk lesion on breast core needle biopsy. AJR Am J Roentgenol. 198, 256–63 (2012).

  9. Kappel C, Seely J, Watters J, Arnaout A, Cordeiro E. A survey of Canadian breast health professionals’ recommendations for high-risk benign breast disease. Can J Surg. 62, 358–60 (2019).

  10. Nizri E, Schneebaum S, Klausner JM, Menes TS. Current management practice of breast borderline lesions--need for further research and guidelines. Am J Surg. 203, 721–5 (2012).

  11. Gao Y, Albert M, Young Lin LL, Lewin AA, Babb JS, Heller SL, et al. What happens after a diagnosis of high-risk breast lesion at stereotactic vacuum-assisted biopsy? An observational study of postdiagnosis management and imaging adherence. Radiology. 287, 423–31 (2018).

  12. Ropka ME, Keim J, Philbrick JT. Patient decisions about breast cancer chemoprevention: A systematic review and meta-analysis. J Clin Oncol. 28, 3090–5 (2010).

  13. Smith SG, Sestak I, Forster A, Partridge A, Side L, Wolf MS, et al. Factors affecting uptake and adherence to breast cancer chemoprevention: A systematic review and meta-analysis. Ann Oncol. 27, 575–90 (2016).

  14. Calhoun BC, Collins LC. Recommendations for excision following core needle biopsy of the breast: a contemporary evaluation of the literature. Histopathology. 68, 138–51 (2016).

  15. American Society of Breast Surgeons Official Statenment: Consensus Guideline on Concordance Assessment of Image-Guided Breast Biopsies and Management of Borderline or High-Risk Lesions 2016 [Available from: https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-Concordance-Assessment-of-Image-Guided-Breast-Biopsies.pdf?v2.

  16. National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2021: Breast Cancer Screening and Diagnosis 2021 [Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf.

  17. Youn I, Kim MJ, Moon HJ, Kim EK. Absence of residual microcalcifications in atypical ductal hyperplasia diagnosed via stereotactic vacuum-assisted breast biopsy: Is surgical excision obviated? J Breast Cancer. 17, 265–9 (2014).

  18. Mesurolle B, Perez JC, Azzumea F, Lemercier E, Xie X, Aldis A, et al. Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: Frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol. 202, 1389–94 (2014).

  19. Caplain A, Drouet Y, Peyron M, Peix M, Faure C, Chassagne-Clement C, et al. Management of patients diagnosed with atypical ductal hyperplasia by vacuum-assisted core biopsy: a prospective assessment of the guidelines used at our institution. Am J Surg. 208, 260–7 (2014).

  20. Eby PR, Ochsner JE, DeMartini WB, Allison KH, Peacock S, Lehman CD. Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. AJR Am J Roentgenol. 192, 229-34 (2009).

  21. Farshid G, Gill PG. Contemporary indications for diagnostic open biopsy in women assessed for screen-detected breast lesions: A ten-year, single institution series of 814 consecutive cases. Breast Cancer Res Treat. 162, 49–58 (2017).

  22. Lewin AA, Mercado CL. Atypical ductal hyperplasia and lobular neoplasia: Update and easing of guidelines. AJR Am J Roentgenol. 214, 265–75 (2020).

  23. Wagoner MJ, Laronga C, Acs G. Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol. 131, 112–21 (2009).

  24. Kohr JR, Eby PR, Allison KH, DeMartini WB, Gutierrez RL, Peacock S, et al. Risk of upgrade of atypical ductal hyperplasia after stereotactic breast biopsy: effects of number of foci and complete removal of calcifications. Radiology. 255, 723–30 (2010).

  25. McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, Gray RJ. Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol. 19, 3264–9 (2012).

  26. Khoury T, Chen X, Wang D, Kumar P, Qin M, Liu S, et al. Nomogram to predict the likelihood of upgrade of atypical ductal hyperplasia diagnosed on a core needle biopsy in mammographically detected lesions. Histopathology. 67, 106–20 (2015).

  27. Menes TS, Rosenberg R, Balch S, Jaffer S, Kerlikowske K, Miglioretti DL. Upgrade of high-risk breast lesions detected on mammography in the breast cancer surveillance consortium. Am J Surg. 207, 24–31 (2014).

  28. Mooney KL, Bassett LW, Apple SK. Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 29, 1471–84 (2016).

  29. Schiaffino S, Calabrese M, Melani EF, Trimboli RM, Cozzi A, Carbonaro LA, et al. Upgrade rate of percutaneously diagnosed pure atypical ductal hyperplasia: Systematic review and meta-analysis of 6458 lesions. Radiology. 294, 76–86 (2020).

  30. Lacambra MD, Lam CC, Mendoza P, Chan SK, Yu AM, Tsang JY, et al. Biopsy sampling of breast lesions: comparison of core needle- and vacuum-assisted breast biopsies. Breast Cancer Res Treat. 132, 917–23 (2012).

  31. Allison KH, Eby PR, Kohr J, DeMartini WB, Lehman CD. Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade. Hum Pathol. 42, 41–50 (2011).

  32. Adrales G, Turk P, Wallace T, Bird R, Norton HJ, Greene F. Is surgical excision necessary for atypical ductal hyperplasia of the breast diagnosed by Mammotome? Am J Surg. 180, 313–5 (2000).

  33. Liberman L, Smolkin JH, Dershaw DD, Morris EA, Abramson AF, Rosen PP. Calcification retrieval at stereotactic, 11-gauge, directional, vacuum-assisted breast biopsy. Radiology. 208, 251–60 (1998).

  34. Philpotts LE, Lee CH, Horvath LJ, Lange RC, Carter D, Tocino I. Underestimation of breast cancer with II-gauge vacuum suction biopsy. AJR Am J Roentgenol. 175, 1047–50 (2000).

  35. Menen RS, Ganesan N, Bevers T, Ying J, Coyne R, Lane D, et al. Long-term safety of observation in selected women following core biopsy diagnosis of atypical ductal hyperplasia. Ann Surg Oncol. 24, 70–6 (2017).

  36. Peña A, Shah SS, Fazzio RT, Hoskin TL, Brahmbhatt RD, Hieken TJ, et al. Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat. 164, 295–304 (2017).

  37. Li X, Ma Z, Styblo TM, Arciero CA, Wang H, Cohen MA. Management of high-risk breast lesions diagnosed on core biopsies and experiences from prospective high-risk breast lesion conferences at an academic institution. Breast Cancer Res Treat. 185, 573–81 (2021).

  38. Schiaffino S, Massone E, Gristina L, Fregatti P, Rescinito G, Villa A, et al. Vacuum assisted breast biopsy (VAB) excision of subcentimeter microcalcifications as an alternative to open biopsy for atypical ductal hyperplasia. Br J Radiol. 91, 20180003 (2018).

  39. Kilgore LJ, Yi M, Bevers T, Coyne R, Lazzaro M, Lane D, et al. Risk of breast cancer in selected women with atypical ductal hyperplasia who do not undergo surgical excision. Ann Surg. Mar. https://doi.org/10.1097/SLA.0000000000004849 [Epub ahead of print]. (2021).

  40. Marti JL. ASO Author reflections: “High-Risk” lesions of the breast: Low risk of cancer, high risk of overtreatment. Ann Surg Oncol. 28, 5156–7 (2021).

  41. Makretsov N. Now, later of never: multicenter randomized controlled trial call--is surgery necessary after atypical breast core biopsy results in mammographic screening settings? Int J Surg Oncol. 2015, 192579 (2015).

  42. Farshid G, Edwards S, Kollias J, Gill PG. Active surveillance of women diagnosed with atypical ductal hyperplasia on core needle biopsy may spare many women potentially unnecessary surgery, but at the risk of undertreatment for a minority: 10-year surgical outcomes of 114 consecutive cases from a single center. Mod Pathol. 31, 395–405 (2018).

  43. Khoury T, Jabbour N, Peng X, Yan L, Quinn M. Atypical ductal hyperplasia and those bordering on ductal carcinoma in situ should be included in the active surveillance clinical trials. Am J Clin Pathol. 153, 131–8 (2020).

  44. Middleton LP, Sneige N, Coyne R, Shen Y, Dong W, Dempsey P, et al. Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting. Cancer Med. 3, 492–9 (2014).

  45. Sen LQ, Berg WA, Hooley RJ, Carter GJ, Desouki MM, Sumkin JH. Core breast biopsies showing lobular carcinoma in situ should be excised and surveillance is reasonable for atypical lobular hyperplasia. AJR Am J Roentgenol. 207, 1132–45 (2016).

  46. Londero V, Zuiani C, Linda A, Girometti R, Bazzocchi M, Sardanelli F. High-risk breast lesions at imaging-guided needle biopsy: usefulness of MRI for treatment decision. AJR Am J Roentgenol. 199, W240–50 (2012).

  47. Khoury T, Li Z, Sanati S, Desouki MM, Chen X, Wang D, et al. The risk of upgrade for atypical ductal hyperplasia detected on magnetic resonance imaging-guided biopsy: a study of 100 cases from four academic institutions. Histopathology. 68, 713–21 (2016).

  48. Rakha EA, Lee AH, Jenkins JA, Murphy AE, Hamilton LJ, Ellis IO. Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Int J Cancer. 129, 1417–24 (2011).

  49. Allen S, Levine EA, Lesko N, Howard-Mcnatt M. Is excisional biopsy and chemoprevention warranted in patients with atypical lobular hyperplasia on core biopsy? Am Surg. 81, 876–8 (2015).

  50. Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allison KH. Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 19, 914–21 (2012).

  51. Subhawong AP, Subhawong TK, Khouri N, Tsangaris T, Nassar H. Incidental minimal atypical lobular hyperplasia on core needle biopsy: correlation with findings on follow-up excision. Am J Surg Pathol. 34, 822–8 (2010).

  52. Shah-Khan MG, Geiger XJ, Reynolds C, Jakub JW, Deperi ER, Glazebrook KN. Long-term follow-up of lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ) diagnosed on core needle biopsy. Ann Surg Oncol. 19, 3131–8 (2012).

  53. Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: Outcomes of prospective excision. Cancer. 119, 1073–9 (2013).

  54. Ferre R, Omeroglu A, Mesurolle B. Sonographic appearance of lesions diagnosed as lobular neoplasia at sonographically guided biopsies. AJR Am J Roentgenol. 208, 669–75 (2017).

  55. Buckley ES, Webster F, Hiller JE, Roder DM, Farshid G. A systematic review of surgical biopsy for LCIS found at core needle biopsy - do we have the answer yet? Eur J Surg Oncol. 40, 168-75 (2014).

  56. Georgian-Smith D, Lawton TJ. Controversies on the management of high-risk lesions at core biopsy from a radiology/pathology perspective. Radiol Clin North Am. 48, 999–1012 (2010).

  57. Savage JL, Jeffries DO, Noroozian M, Sabel MS, Jorns JM, Helvie MA. Pleomorphic lobular carcinoma in situ: imaging features, upgrade rate, and clinical outcomes. AJR Am J Roentgenol. 211, 462–7 (2018).

  58. Kuba MG, Murray MP, Coffey K, Calle C, Morrow M, Brogi E. Morphologic subtypes of lobular carcinoma in situ diagnosed on core needle biopsy: clinicopathologic features and findings at follow-up excision. Mod Pathol. 34, 1495–506 (2021).

  59. Downs-Kelly E, Bell D, Perkins GH, Sneige N, Middleton LP. Clinical implications of margin involvement by pleomorphic lobular carcinoma in situ. Arch Pathol Lab Med. 135, 737–43 (2011).

  60. Shamir ER, Chen YY, Chu T, Pekmezci M, Rabban JT, Krings G. Pleomorphic and florid lobular carcinoma in situ variants of the breast: A clinicopathologic study of 85 cases with and without invasive carcinoma from a single academic center. Am J Surg Pathol. 43, 399–408 (2019).

  61. VandenBussche CJ, Khouri N, Sbaity E, Tsangaris TN, Vang R, Tatsas A, et al. Borderline atypical ductal hyperplasia/low-grade ductal carcinoma in situ on breast needle core biopsy should be managed conservatively. Am J Surg Pathol. 37, 913–23 (2013).

  62. Pawloski KR, Christian N, Knezevic A, Wen HY, Van Zee KJ, Morrow M, et al. Atypical ductal hyperplasia bordering on DCIS on core biopsy is associated with higher risk of upgrade than conventional atypical ductal hyperplasia. Breast Cancer Res Treat. 184, 873–80 (2020).

  63. Nagi CS, O’Donnell JE, Tismenetsky M, Bleiweiss IJ, Jaffer SM. Lobular neoplasia on core needle biopsy does not require excision. Cancer. 112, 2152–8 (2008).

  64. Laws A, Katlin F, Nakhlis F, Chikarmane SA, Schnitt SJ, King TA. Atypical lobular hyperplasia and classic lobular carcinoma in situ can be safely managed without surgical excision. Ann Surg Oncol. 29, 1660–7 (2022).

  65. Nakhlis F, Gilmore L, Gelman R, Bedrosian I, Ludwig K, Hwang ES, et al. Incidence of adjacent synchronous invasive carcinoma and/or ductal carcinoma in-situ in patients with lobular neoplasia on core biopsy: Results from a prospective multi-institutional registry (TBCRC 020). Ann Surg Oncol. 23, 722–8 (2016).

  66. Schmidt H, Arditi B, Wooster M, Weltz C, Margolies L, Bleiweiss I, et al. Observation versus excision of lobular neoplasia on core needle biopsy of the breast. Breast Cancer Res Treat. 168, 649–54 (2018).

  67. Doyle EM, Banville N, Quinn CM, Flanagan F, O’Doherty A, Hill AD, et al. Radial scars/complex sclerosing lesions and malignancy in a screening programme: incidence and histological features revisited. Histopathology. 50, 607–14 (2007).

  68. Becker L, Trop I, David J, Latour M, Ouimet-Oliva D, Gaboury L, et al. Management of radial scars found at percutaneous breast biopsy. Can Assoc Radiol J. 57, 72–8 (2006).

  69. Lopez-Medina A, Cintora E, Mugica B, Opere E, Vela AC, Ibanez T. Radial scars diagnosed at stereotactic core-needle biopsy: surgical biopsy findings. Eur Radiol. 16, 1803–10 (2006).

  70. Pujara AC, Hui J, Wang LC. Architectural distortion in the era of digital breast tomosynthesis: outcomes and implications for management. Clin Imaging. 54, 133–7 (2019).

  71. Li Z, Ranade A, Zhao C. Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. Hum Pathol. 48, 76–80 (2016).

  72. Neal L, Sandhu NP, Hieken TJ, Glazebrook KN, Mac Bride MB, Dilaveri CA, et al. Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc. 89, 536–47 (2014).

  73. Nassar A, Conners AL, Celik B, Jenkins SM, Smith CY, Hieken TJ. Radial scar/complex sclerosing lesions: a clinicopathologic correlation study from a single institution. Ann Diagn Pathol. 19, 24–8 (2015).

  74. Resetkova E, Edelweiss M, Albarracin CT, Yang WT. Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years’ of experience at a single institution. Breast Cancer Res Treat. 127, 335–43 (2011).

  75. Farshid G, Buckley E. Meta-analysis of upgrade rates in 3163 radial scars excised after needle core biopsy diagnosis. Breast Cancer Res Treat. 174, 165–77 (2019).

  76. Kraft E, Limberg JN, Dodelzon K, Newman LA, Simmons R, Swistel A, et al. Radial scars and complex sclerosing lesions of the breast: prevalence of malignancy and natural history under active surveillance. Ann Surg Oncol. 28, 5149–55 (2021).

  77. Nakhlis F, Lester S, Denison C, Wong SM, Mongiu A, Golshan M. Complex sclerosing lesions and radial sclerosing lesions on core needle biopsy: Low risk of carcinoma on excision in cases with clinical and imaging concordance. Breast J. 24, 133–8 (2018).

  78. Foley NM, Racz JM, Al-Hilli Z, Livingstone V, Cil T, Holloway CM, et al. An international multicenter review of the malignancy rate of excised papillomatous breast lesions. Ann Surg Oncol. 22 Suppl 3, S385–90 (2015).

  79. Fu CY, Chen TW, Hong ZJ, Chan DC, Young CY, Chen CJ, et al. Papillary breast lesions diagnosed by core biopsy require complete excision. Eur J Surg Oncol. 38, 1029–35 (2012).

  80. Cyr AE, Novack D, Trinkaus K, Margenthaler JA, Gillanders WE, Eberlein TJ, et al. Are we overtreating papillomas diagnosed on core needle biopsy? Ann Surg Oncol. 18, 946–51 (2011).

  81. Kang HJ, Kwon SY, Kim A, Kim WG, Kim EK, Kim AR, et al. A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification. J Pathol Transl Med. 55, 380–7 (2021).

  82. NHS Breast Screening Programme Clinical guidance for breast cancer screening assessment [Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/567600/Clinical_guidance_for_breast__cancer_screening__assessment_Nov_2016.pdf.

  83. Chen YA, Mack JA, Karamchandani DM, Zaleski MP, Xu L, Dodge DG, et al. Excision recommended in high-risk patients: Revisiting the diagnosis of papilloma on core biopsy in the context of patient risk. Breast J. 25, 232–6 (2019).

  84. Qiu L, Mais DD, Nicolas M, Nanyes J, Kist K, Nazarullah A. Diagnosis of papillary breast lesions on core needle biopsy: Upgrade rates and interobserver variability. Int J Surg Pathol. 27, 736–43 (2019).

  85. Jakate K, De Brot M, Goldberg F, Muradali D, O’Malley FP, Mulligan AM. Papillary lesions of the breast: impact of breast pathology subspecialization on core biopsy and excision diagnoses. Am J Surg Pathol. 36, 544–51 (2012).

  86. Nasehi L, Sturgis CD, Sharma N, Turk P, Calhoun BC. Breast cancer risk associated with benign intraductal papillomas initially diagnosed on core needle biopsy. Clin Breast Cancer. 18, 468–73 (2018).

  87. Swapp RE, Glazebrook KN, Jones KN, Brandts HM, Reynolds C, Visscher DW, et al. Management of benign intraductal solitary papilloma diagnosed on core needle biopsy. Ann Surg Oncol. 20, 1900–5 (2013).

  88. Jaffer S, Bleiweiss IJ, Nagi C. Incidental intraductal papillomas (< 2 mm) of the breast diagnosed on needle core biopsy do not need to be excised. Breast J. 19, 130–3 (2013).

  89. Grimm LJ, Bookhout CE, Bentley RC, Jordan SG, Lawton TJ. Concordant, non-atypical breast papillomas do not require surgical excision: A 10-year multi-institution study and review of the literature. Clin Imaging. 51, 180–5 (2018).

  90. Ma Z, Arciero CA, Styblo TM, Wang H, Cohen MA, Li X. Patients with benign papilloma diagnosed on core biopsies and concordant pathology-radiology findings can be followed: experiences from multi-specialty high-risk breast lesion conferences in an academic center. Breast Cancer Res Treat. 183, 577–84 (2020).

  91. Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Terasaki H, Hirai Y, et al. Management of breast papillary lesions diagnosed in ultrasound-guided vacuum-assisted and core needle biopsies. Histopathology. 66, 565–76 (2015).

  92. Wyss P, Varga Z, Rossle M, Rageth CJ. Papillary lesions of the breast: outcomes of 156 patients managed without excisional biopsy. Breast J. 20, 394–401 (2014).

  93. Nayak A, Carkaci S, Gilcrease MZ, Liu P, Middleton LP, Bassett RL, Jr., et al. Benign papillomas without atypia diagnosed on core needle biopsy: experience from a single institution and proposed criteria for excision. Clin Breast Cancer. 13, 439–49 (2013).

  94. Bennett LE, Ghate SV, Bentley R, Baker JA. Is surgical excision of core biopsy proven benign papillomas of the breast necessary? Acad Radiol. 17, 553–7 (2010).

  95. Holley SO, Appleton CM, Farria DM, Reichert VC, Warrick J, Allred DC, et al. Pathologic outcomes of nonmalignant papillary breast lesions diagnosed at imaging-guided core needle biopsy. Radiology. 265, 379–84 (2012).

  96. Sohn V, Keylock J, Arthurs Z, Wilson A, Herbert G, Perry J, et al. Breast papillomas in the era of percutaneous needle biopsy. Ann Surg Oncol. 14, 2979–84 (2007).

  97. Limberg J, Kucher W, Fasano G, Hoda S, Michaels A, Marti JL. Intraductal papilloma of the breast: prevalence of malignancy and natural history under active surveillance. Ann Surg Oncol. 28, 6032–40 (2021).

  98. Nakhlis F, Baker GM, Pilewskie M, Gelman R, Calvillo KZ, Ludwig K, et al. The incidence of adjacent synchronous invasive carcinoma and/or ductal carcinoma in situ in patients with intraductal papilloma without atypia on core biopsy: Results from a prospective multi-institutional registry (TBCRC 034). Ann Surg Oncol. 28, 2573–8 (2020).

  99. Berg WA, Berg JM, Sickles EA, Burnside ES, Zuley ML, Rosenberg RD, et al. Cancer yield and patterns of follow-up for BI-RADS category 3 after screening mammography recall in the national mammography database. Radiology. 296, 32–41 (2020).

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The Introduction and Discussion were written jointly by the authors. The sections arguing for immediate surgical excision of high-risk and selected benign lesions were written by AH and HG. The sections proposing nonoperative management of selected patients with high-risk and selected benign lesions were written by BC.

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Correspondence to Benjamin C. Calhoun.

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Dr. Calhoun is a Member of the Oncology Advisory Board for Luminex Corp. Dr. Gilmore is a Consultant for Agendia, Inc. and a Member of the Digital Pathology Advisory Board for Sectra. Dr. Harbhajanka has no financial relationships to disclose.

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Harbhajanka, A., Gilmore, H.L. & Calhoun, B.C. High-risk and selected benign breast lesions diagnosed on core needle biopsy: Evidence for and against immediate surgical excision. Mod Pathol (2022). https://doi.org/10.1038/s41379-022-01092-w

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