Jacobs et al listed nonmalignant lesions identified on needle core biopsy of the breast that should undergo surgical excision. This is to ensure that no more significant lesion is present. The authors are from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.


Lesions that should be excised if identified on a needle core biopsy of the breast:

(1) atypical ductal hyperplasia

(2) atypical lobular hyperplasia or lobular carcinoma in situ (lobular neoplasia)

(3) papillary lesion

(4) fibroadenoma with:

(4a) atypical ductal hyperplasia or

(4b) stromal proliferation suggesting a phyllodes tumor

(5) radial scar

(6) columnar cell lesion with hyperplastic features (see below)

(7) mucocele-like lesion or stromal mucin pools


Classification of Brogi and Tan for columnar cell lesion:

(1) mild (nonhyperplastic): single columnar cell layer

(2) moderate:2-4 columnar cell layers

(3) severe: >= 5 columnar cell layers and/or micropapillary tufts and/or cribiform spaces

Moderate and severe columnar cell lesions should be excised.


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