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Management of the High-Risk Breast Lesion

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Breast Disease

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Abstract

The clinical management of high-risk breast lesions is intellectually challenging, continually evolving over time and occasionally controversial. The evaluation of all breast conditions begins with a thorough history and physical exam, appropriate breast imaging, and cytologic or histologic evaluation when indicated. Percutaneous core needle biopsy (CNB) has become the diagnostic modality of choice for both palpable and non-palpable breast lesions when histologic assessment is desired. In the treatment of breast cancer, preoperative diagnosis by CNB offers many advantages over open surgical biopsy. CNB provides preoperative clinical staging and tumor marker assessment, enables discussion of neoadjuvant options, and increases the rate of breast-conserving therapy. Yet, the majority of image-detected breast lesions are benign, and most patients who undergo a breast biopsy will not have a diagnosis of malignancy. When there is concordance among clinical history, physical examination, imaging, and needle biopsy pathology, CNB may obviate the need for surgery to prevent under- and overtreatment of patients. However, some CNB findings are considered “borderline” because the CNB reveals a nonmalignant diagnosis, but cancer might be present at the biopsy site, implying a sampling error.

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Authors and Affiliations

  1. Department of General Surgery, Gundersen Health System, La Crosse, WI, USA

    Jared Linebarger MD

  2. Norma J Vinger Center for Breast Care (NJVCBC), La Crosse, WI, USA

    Jared Linebarger MD

  3. Department of Medical Education, Gundersen Lutheran Medical Foundation (GLMF), La Crosse, WI, USA

    Jon Zellmer MD

  4. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, 550 Peachtree Street, 9th floor, Atlanta, GA, 30308, USA

    Monica Rizzo MD, FACS

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  1. Advocate Center for Breast Health, Advocate Cancer Institute, Oak Lawn, Illinois, USA

    Adam I. Riker

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Linebarger, J., Zellmer, J., Rizzo, M. (2015). Management of the High-Risk Breast Lesion. In: Riker, A. (eds) Breast Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1145-5_5

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