How Do We Approach Benign Proliferative Lesions?

  • Faina Nakhlis
Breast Cancer (B Overmoyer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Breast Cancer


Purpose of Review

The aim of this review is to summarize recently published literature addressing atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia [ALH] and classic lobular carcinoma in situ [C-LCIS]), non-classic lobular carcinoma in situ (NC-LCIS), papillary lesions, and flat epithelial atypia (FEA).

Recent Findings

While ADH, ALN, and C-LCIS are well-established markers of an increased risk of future breast cancers, the risk implications are less clear for papillary lesions and FEA. NC-LCIS is the least well-characterized lesion, with scant published literature on its natural history and surgical management when encountered on needle biopsy.


Recent data suggest that lobular neoplasia on core biopsy of a BI-RADS ≤ 4 concordant lesion does not require an excision, while ADH, atypical papillomas, and NC-LCIS should be excised. Evidence on FEA and papillomas without atypia suggests a low risk of upgrade on excision, and prospective studies on the upgrade of these lesions are ongoing.


Atypical ductal hyperplasia (ADH) Lobular neoplasia (atypical lobular hyperplasia (ALH) and classic lobular carcinoma in situ (C-LCIS)) Non-classic lobular carcinoma in situ (NC-LCIS) Papillary breast lesions Flat epithelial atypia (FEA) 


Compliance with Ethical Standards

Conflict of Interest

Faina Nakhlis declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Surgical Oncology, Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer CenterBostonUSA

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