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Atypia and lobular carcinoma in situ: High risk lesions of the breast

Michael S Sabel, MD
Laura C Collins, MD
Section Editor
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editor
Wenliang Chen, MD, PhD


Benign lesions of the breast are generally categorized into three groups: nonproliferative, proliferative without atypia, and proliferative with atypia. (See "Overview of benign breast disease".)

Proliferative lesions with atypia include atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), flat epithelial atypia (FEA), and lobular carcinoma in situ (LCIS). These lesions are considered high risk because they are associated with an increase in the patient’s future risk of developing breast cancer. They are generally not considered premalignant lesions, as the cancers that subsequently develop may occur anywhere in the breasts, not necessarily at the site of the atypia. Therefore, when these high-risk lesions are discovered, the focus should be on careful surveillance and consideration of risk reduction strategies.

The epidemiology, natural history, and treatment of women with atypia and LCIS will be reviewed here. The pathology of ductal carcinoma in situ and the diagnosis and management of ductal carcinoma in situ (DCIS) are discussed elsewhere. (See "Breast ductal carcinoma in situ: Epidemiology, clinical manifestations, and diagnosis" and "Ductal carcinoma in situ: Treatment and prognosis" and "Pathology of breast cancer".)


Atypical hyperplasia (AH) includes both atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH). ADH is usually found as the target lesion on biopsy of mammographic microcalcifications whereas ALH is usually an incidental finding on breast biopsies performed for other reasons (eg, abnormal mammogram, breast mass).

Atypical ductal hyperplasia – Atypical ductal hyperplasia (ADH) is characterized by a proliferation of uniform epithelial cells with monomorphic round nuclei filling part, but not all, of the involved duct. ADH shares some of the cytologic and architectural features of low-grade ductal carcinoma in situ (DCIS) [1].


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Literature review current through: Sep 2016. | This topic last updated: Aug 20, 2014.
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