Our Summary

This research paper discusses the common occurrence of high-risk lesions or abnormal areas found in breast tissue during image-guided needle biopsies. These lesions are typically concerning because they can possibly turn into cancer and often indicate an increased risk of breast cancer over a person’s lifetime. In the past, surgery was typically the go-to treatment to remove these lesions. However, recent research suggests that using a vacuum-assisted method to remove the lesion, or simply monitoring the lesion closely, might be enough for certain types. The paper reviews the latest research and gives management recommendations for the most common types of these lesions.

FAQs

  1. What are high-risk lesions in breast biopsy?
  2. What are the management recommendations for high-risk lesions in a breast biopsy?
  3. What alternatives to surgical excision are there for high-risk lesions found in a breast biopsy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about breast biopsy is to stay informed and ask questions about the type of lesion found, the recommended course of action, and what the next steps will be. It is important to advocate for yourself and make sure you understand your diagnosis and treatment plan. Additionally, it is important to follow up with your doctor regularly and attend any recommended screenings or follow-up appointments to monitor for any changes in the lesion.

Suitable For

Patients who are typically recommended for breast biopsy include those with high-risk lesions or lesions of uncertain malignant potential found on imaging-guided needle biopsy. These patients may have a high lifetime risk for breast cancer and may require further evaluation to determine the nature of the lesion and the appropriate course of treatment. High-risk lesions may include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, radial scar, and papillomas. Patients with these types of lesions may be recommended for surgical excision, vacuum-assisted excision, or surveillance, depending on the specific characteristics of the lesion and the individual’s risk factors. Management recommendations may vary among institutions, but recent studies have shown that some high-risk lesions may not require surgical excision and can be managed with less invasive approaches. It is important for patients with high-risk breast lesions to follow up with their healthcare provider to discuss the results of their biopsy and determine the most appropriate course of action.

Timeline

Before breast biopsy:

  1. Patient may notice a suspicious lump or abnormality in the breast during a self-exam or routine screening mammogram.
  2. Patient consults with their healthcare provider who recommends a breast biopsy to further evaluate the abnormality.
  3. Patient undergoes imaging studies such as ultrasound or MRI to locate the precise location of the abnormality.
  4. Patient may undergo a pre-biopsy consultation to discuss the procedure, risks, and potential outcomes.

After breast biopsy:

  1. Patient undergoes the biopsy procedure, which can be done using a needle or surgical excision, under local anesthesia.
  2. Patient may experience some discomfort, bruising, or swelling at the biopsy site following the procedure.
  3. Biopsy samples are sent to a pathology lab for analysis to determine if the abnormality is benign or malignant.
  4. Patient receives the biopsy results from their healthcare provider, which will guide further treatment options if the abnormality is found to be malignant.
  5. Depending on the results, patient may require additional imaging studies, surgery, or other treatments. If the abnormality is benign, patient may be advised to undergo regular follow-up screenings.

What to Ask Your Doctor

  1. What type of high-risk lesion or lesion of uncertain malignant potential was found on my breast biopsy?
  2. What is the likelihood that this lesion could be cancerous?
  3. What are the treatment options for this type of lesion?
  4. What are the risks and benefits of surgical excision versus surveillance for this type of lesion?
  5. How often should I have follow-up imaging or biopsies to monitor this lesion?
  6. What is my lifetime risk for developing breast cancer with this type of lesion?
  7. Are there any lifestyle changes or preventative measures I should consider to reduce my risk of breast cancer?
  8. Should I seek a second opinion or consult with a specialist about my biopsy results and treatment options?

Reference

Authors: Horvat JV. Journal: Semin Ultrasound CT MR. 2023 Feb;44(1):46-55. doi: 10.1053/j.sult.2022.10.005. Epub 2022 Oct 29. PMID: 36792273