Diagnosis | Management after core needle biopsy[1] | Upgrade rate with excision | Management of margins after excision | Relative risk for invasive cancer | Risk reduction with active surveillance and chemoprevention | |
Atypical ductal hyperplasia (ADH) | Found on biopsy performed for microcalcifications on screening mammogram | Surgical excision for most patients | 10 to 20%[2] | No re-excision for margins | 3.1 to 4.7[2] | Yes |
Atypical lobular hyperplasia (ALH) | Incidental finding on biopsy performed for other reasons | Surgical excision for discordance or presence of other high-risk lesion Observation for other lesions | <3% for concordant, small-volume disease[2] | No re-excision for margins | 3.1 to 5.9[2] | Yes |
Lobular carcinoma in situ (LCIS) | Incidental finding on biopsy performed for other reasons | Surgical excision for non-classic features (pleomorphic, comedo necrosis, signet ring, or apocrine), or for discordance Observation for concordant classic LCIS | <5% for concordant, small-volume disease[2] | Re-excision to negative margins for pleomorphic LCIS No re-excision for margins for classic LCIS | 6.9 to 11[2] | Yes |
Flat epithelial atypia (FEA) | Found on biopsy performed for microcalcifications on screening mammogram | Surgical excision for discordance or FEA associated with residual microcalcification Observation for concordant pure FEA | 0 to 3.2% for pure FEA[2] | No re-excision for margins | 1.47[3] | No for pure FEA (return to routine surveillance) |
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