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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), 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 [1]. While there is evidence to suggest that at least some of these lesions may be nonobligate precursor lesions [2], they are generally managed as risk indicators rather than precursor lesions, as the cancers that subsequently develop may occur in either breast and 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. Flat epithelial atypia (FEA) is also an atypical proliferation, but this lesion does not appear to convey an elevation in risk beyond that of any associated proliferative lesions present.

The diagnosis, pathology, and management of patients with ADH, ALH, LCIS, and FEA will be reviewed here. Ductal carcinoma in situ (DCIS) is 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).

Atypical ductal hyperplasia (ADH)

Diagnosis — ADH is usually diagnosed by core needle biopsy (CNB) as the target lesion on biopsy of mammographic microcalcifications.

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
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