Histological lesions of risk for breast carcinoma. An updated survival guide

Histological lesions of risk of breast cancer are proliferative epithelial lesions associated with a higher incidence of breast cancer. The magnitude of the risk is related to the presence of epithelial atypia. Lesions with atypical hyperplasia have a relative risk of cancer 4 times higher than the control population. Proliferative epithelial lesions present diverse histological characteristics and must be appropriately classified. They include usual ductal hyperplasia, radial scar and complex sclerosing lesions, sclerosing adenosis, apocrine adenosis, microglandular adenosis, papillary lesions, atypical ductal hyperplasia, flat epithelial atypia, lobular neoplasia. They propose the differential diagnosis with ductal carcinoma in situ and invasive carcinoma. When risk lesions type B3 are diagnosed in needle-core and vacuum-assisted biopsies, the underestimation rates for invasive carcinoma should be below 5% and below 10% for ductal carcinoma in situ. In this review, we describe the clinical and histological aspects of the different entities and discuss the possible management options depending on the diagnostic category and the lesion size. Correct management requires close collaboration between surgeons, radiologists, and pathologists.