Selective surgical excision of high-risk lesions

Samantha Warwar, Swati Kulkarni*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Intraductal papilloma, flat epithelial atypia, radial scar, atypical lobular hyperplasia, and lobular carcinoma in situ have historically been referred to as high-risk lesions and managed with routine surgical excision after diagnosis on core needle biopsy. The misnomer high-risk stems from high rates of upgrade to malignancy reported in historic literature. However, recent studies have found much lower upgrade rates, <2%, than previously thought. These findings are explained by advances in imaging technology, larger-bore biopsy needles, and emphasis on radiology-pathology concordance. Concordant lesions have a low upgrade risk and can be managed with radiographic and clinical surveillance instead of surgical excision. Surgical de-escalation is feasible for many of these lesions with careful multidisciplinary review and a detailed risk–benefit discussion with patients.

Original languageEnglish (US)
Pages (from-to)125-128
Number of pages4
JournalSurgery (United States)
Issue number1
StatePublished - Jul 2023

ASJC Scopus subject areas

  • Surgery


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