Abstract
The majority of benign mammary lesions have their atypical or malignant variant. On certain occasions, the differentiation by the pathologist is difficult, as the histopathological analysis must follow strict diagnostic criteria. The unprecise benign characterization of mammary lesions may lead to inadequate clinical-surgical follow-up and consequently the progression of locoregional disease, causing definitive sequels for patients. The differential diagnosis between benign lesions from malignant neoplasms is fundamental to the appropriate clinical-surgical indication.
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Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ, editors. WHO classification of tumours of the breast. Lyon: IARC; 2012. Pathological, clinical and radiological findings related to the prognosis of the different types of lesions in mammary pathology, according to the most recent classification of the World Health Organization (WHO)
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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. 2017. Radiant sclerosing lesions (RSL) and complex lesions (CEL) are found to be unusual in biopsies, associated to divergent diagnoses obtained by surgical specimens, ranging between 0% and 23%, presenting, therefore, controversial management. In this study, it was sought to determine the risk of malignancy ratio between RSL/CEL, diagnosed in biopsies, aiming the evaluating the risk of future cancer when performed solely by clinical follow-ups of these lesions, without surgical excision. Retrospectively, 118 cases of RSL/CEL in biopsies between 2005 and 2014 were analyzed. Among the 98 patients evaluated, in 34 cases (35%) surgical excisions were performed and in 64 (65%) clinical follow-up was performed. A malignancy rate of 9% was observed in surgical specimens of BIRADS lesions > 4c characterized as RSL/CEL in biopsies. In patients with concordant biopsies and BIRADS 4a, or in lesions weakly suspicioned, subjected to observation, a low subsequent rate of ipsilateral carcinoma was found. Despite this data, further studies are needed to confirm that clinical accompaniment may be a reasonable alternative to surgical excision whenever facing a RSL/CEL diagnosis in concordant biopsies, in BIRADS 4a or in non-palpable lesions less likely to be suspicioned.
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Luzzatto, F. (2019). Histopathological Classification of Benign Lesions. In: Novita, G., Frasson, A., Millen, E., Zerwes, F., Cavalcante, F. (eds) Breast Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-13636-9_11
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DOI: https://doi.org/10.1007/978-3-030-13636-9_11
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