High-Risk Lesion of Breast

Breast lesions with ambiguous malignant behavior are classified as high-risk lesions. They comprise a group of identities with a varying risk of developing invasive malignancy, subsequently. Owing to the widespread acceptance and application of screening programs for breast cancer and the consequent increase in the use of mammography, the incidence of these high-risk lesions, which previously went undetected, has increased manifold. Today, these lesions constitute around 3–21% of all breast lesions. Traditionally these lesions are not exactly considered precursors of malignancy, because both breasts are at an increased risk and the subsequent invasive malignancy can develop anywhere, not necessarily at the site of these high-risk lesions. However, they still act as substantial risk indicators, predicting the risk of developing invasive carcinoma subsequently. The presence of atypia in these lesions furthers the risk of invasive carcinoma. To begin with, open excision was advocated as a blanket management for all these lesions. But now, we are slowly moving toward a more tailored approach in the management of these lesions that are more lesion and patient-specific so as to attempt to strike a balance between overtreating and undertreating. Current guidelines recommend imaging follow-up, vacuum-assisted biopsy (VAB), vacuum-assisted excision (VAE), or an open excision.