title: Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy.
abstract: Imaging abnormalities detected by mammographic screening often lead to diagnostic evaluations, with suspicious abnormalities subjected to image-guided core needle biopsy (CNB) to exclude malignancy. Most CNBs reveal benign pathological alterations, termed benign breast disease (BBD). Adoption of CNB presents challenges with pathologic classification of breast abnormalities and management of patients with benign or atypical histological findings. Patient management and counseling after CNB diagnosis of BBD depends on postbiopsy determination of radiologic-pathologic concordancy. Communication between radiologists and pathologists is crucial in patient management. Management is dependent on the histological type of BBD. Patients with concordant pathologic imaging results can be reassured of benign biopsy findings and advised about the future risk of developing breast cancer. Surgical consultation is advised for patients with discordant findings, symptomatic patients, and high-risk lesions. This review highlights benign breast lesions that are encountered on CNB and summarizes management strategies. For this review, we conducted a search of PubMed, with no date limitations, and used the following search terms (or a combination of terms): atypical ductal hyperplasia, atypical hyperplasia, atypical lobular hyperplasia, benign breast disease, cellular fibroepithelial lesions, columnar cell lesions, complex sclerosing lesion, core needle biopsy, fibroadenomas, flat epithelial atypia, lobular carcinoma in situ, lobular neoplasia, mucocele-like lesions, phyllodes tumor, pseudoangiomatous stromal hyperplasia, radial scar, and vascular lesions. The selection of references included in this review was based on study relevance and quality. We used additional articles culled from the bibliographies of retrieved articles to examine the published evidence for risk factors of BBD.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: neal.lonzetta@mayo.edu.
authors.forename: Lonzetta
authors.initials: L
authors.lastname: Neal
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Sandhu
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN.
authors.forename: Katrina N
authors.initials: KN
authors.lastname: Glazebrook
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Maire Brid
authors.initials: MB
authors.lastname: Mac Bride
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Dilaveri
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Dietlind L
authors.initials: DL
authors.lastname: Wahner-Roedler
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ghosh
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Visscher
mesh_terms: D000328:Adult; D000368:Aged; D000798:Angiomatosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D002278:Carcinoma in Situ / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D007150:Immunohistochemistry; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D018570:Risk Assessment; D012680:Sensitivity and Specificity