Breast Lesion Diagnosis and Management Strategies

The diagnosis and management of breast lesions have evolved towards a more nuanced and patient-centred approach, integrating advances in imaging, pathology and minimally invasive techniques. Digital mammography and targeted ultrasound remain cornerstones of screening and diagnostic work-up, while magnetic resonance imaging and contrast-enhanced modalities increasingly aid in lesion characterisation. Histopathological classification ranges from benign findings through high-risk lesions of uncertain malignant potential (so-called B3 lesions) to in situ and invasive carcinomas. Core-needle and vacuum-assisted biopsies enable tissue sampling with reduced morbidity, facilitating risk-stratified decision-making. Consensus guidelines advocate excision for certain lesions with higher upgrade rates, while surveillance or image-guided removal is acceptable for others to minimise overtreatment. Multidisciplinary review underpins individualised management, balancing the imperative for early cancer detection against the harm of unnecessary interventions. Ongoing research targets molecular markers to refine prognostic assessment and to guide both surgical and non-surgical strategies in diverse healthcare settings.

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Breast Lesion Diagnosis and Management Strategies publication trend

The graph below shows the total number of articles in breast lesion diagnosis and management strategies across all publications each year (not limited to Nature Index journals).

Technical terms

B3 lesions: A heterogeneous group of breast abnormalities with uncertain malignant potential identified on biopsy that require risk-adapted management.

Atypical ductal hyperplasia (ADH): A proliferation of atypical ductal epithelial cells that carries a variable risk of progression to carcinoma and often prompts surgical excision.

Core-needle biopsy (CNB): A minimally invasive method using a hollow needle to obtain cylindrical samples of breast tissue for histological examination.

Vacuum-assisted biopsy (VAB): An image-guided technique employing a vacuum-powered probe to acquire larger contiguous tissue samples, sometimes excising small lesions entirely.

Contrast-enhanced ultrasound (CEUS): An ultrasound modality using microbubble contrast agents to assess vascular patterns within lesions and improve diagnostic accuracy.

References

1. High-risk lesions of the breast: concurrent diagnostic tools and management recommendations. Insights into Imaging (2021).
2. Atypia detected during breast screening and subsequent development of cancer: observational analysis of the Sloane atypia prospective cohort in England.. The BMJ (2024).
3. Contrast-enhanced ultrasound to predict malignant upgrading of atypical ductal hyperplasia. Breast Cancer Research (2024).
4. Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Virchows Archiv (2023).