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Revista de Senología y Patología Mamaria - Journal of Senology and Breast Disease
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Review
Histological lesions of risk for breast carcinoma. An updated survival guide
Lesiones histológicas de riesgo de cáncer de mama. Guía de supervivencia actualizada
Vicente Marco Molina
Corresponding author
vmarcomolina@gmail.com

Corresponding author.
, Felip García Hernández
Servicio de Anatomía Patológica, Hospital Quirónsalud Barcelona, Barcelona, Spain
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Usual ductal hyperplasia showing intraluminal cellular proliferation&#46; The cells are arranged in streams&#44; and they tend to overlap&#46; They delineate irregular-shaped spaces&#46; &#40;B&#41; Radial scar showing a central area of sclerosis and a lobulocentric architecture&#46; &#40;C&#41; Complex sclerosing lesion with irregular acinar proliferation&#44; surrounded by collagenous stroma&#46; &#40;D&#41; Sclerosing adenosis is characterized by the proliferation of epithelial and myoepithelial cells embedded in a collagenous stroma&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Histological lesions at risk for breast cancer are epithelial proliferative lesions that are associated with a higher incidence of invasive breast carcinoma&#46; The magnitude of the risk is related to the existence of epithelial atypia&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">Epidemiological studies indicate the importance of histological classifications &#40;<a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bb0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Benign proliferative lesions with atypia have a higher relative risk &#40;RR&#41; of breast cancer than the control population&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0015" class="elsevierStylePara elsevierViewall">In patients with carcinoma in situ&#44; ductal&#44; or lobular&#44; the risk affects primarily the quadrant of the breast where the initial lesion is diagnosed&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> These lesions are considered non-obligatory precursors of invasive breast carcinoma&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">Lobular carcinoma in situ &#40;LCIS&#41; behaves like risk lesions and as non-obligatory precursors of breast cancer since their presence indicates a greater bilateral risk of developing invasive carcinoma&#46; Still&#44; the risk is significantly higher for the quadrant where LCIS is first diagnosed&#46;<a class="elsevierStyleCrossRefs" href="#bb0025"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">With the implementation of core needle biopsies &#40;CNB&#41; and vacuum-assisted biopsies &#40;VAB&#41; in patients that present lesions detected by imaging&#44; the question of the appropriate management arises&#46; International societies have recently published consensus and guidelines for diagnosing and treating breast lesions of uncertain malignant potential&#46;<a class="elsevierStyleCrossRefs" href="#bb0040"><span class="elsevierStyleSup">8&#8211;11</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">This study aims to review the diagnostic criteria of benign proliferative lesions of the breast&#44; the associated risk of carcinoma&#44; and management based on the diagnosis with minimally invasive biopsies &#40;CNB or VAB&#41; and vacuum-assisted excision &#40;VAE&#41;&#44; which aims to remove a similar amount of tissue as diagnostic surgical excision&#46;<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Usual ductal hyperplasia &#40;UDH&#41;</span><p id="p0035" class="elsevierStylePara elsevierViewall">UDH presents a heterogeneous intraductal proliferation of cells without nuclear atypia &#40;<a class="elsevierStyleCrossRef" href="#f0005">Fig&#46; 1</a>A&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0040" class="elsevierStylePara elsevierViewall">It raises the differential diagnosis with atypical ductal hyperplasia &#40;ADH&#41; and low or intermediate-grade ductal carcinoma in situ &#40;DCIS&#41;&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">The immunohistochemical &#40;IHC&#41; study with high molecular weight cytokeratins&#44; reactive with basal&#47;myoepithelial cells &#40;CK 5&#47;6&#44; CK 14&#41;&#44; is helpful since cell proliferation is patchily positive in UDH and negative in ADH and DCIS&#46;<a class="elsevierStyleCrossRefs" href="#bb0060"><span class="elsevierStyleSup">12&#8211;14</span></a> Likewise&#44; stains with estrogen and progesterone receptors are positive in isolated cells in UDH but uniformly positive in ADH&#47;DCIS&#46;<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a></p><p id="p0050" class="elsevierStylePara elsevierViewall">The etiopathogenesis of UDH needs to be better understood&#46; The studies by Boecker et al&#46; propose that cell proliferation is formed by progenitor cells of the ductal epithelium and myoepithelium&#46;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a></p><p id="p0055" class="elsevierStylePara elsevierViewall">UDH confers a low RR of infiltrating breast cancer &#40;RR&#46; 1&#46;5&#8211;2&#41;&#59; therefore&#44; when it is detected in CNB or VAB&#44; a surgical biopsy is not indicated&#46;<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Radial scar &#40;&#60;1&#8239;cm&#41; and complex sclerosing lesion &#40;&#62;1&#8239;cm&#41;</span><p id="p0060" class="elsevierStylePara elsevierViewall">They are asymptomatic and rarely palpable lesions&#44; being able to simulate the image and histology of an invasive carcinoma &#40;<a class="elsevierStyleCrossRef" href="#f0005">Fig&#46; 1</a>B and C&#41;&#46; They are detected in 0&#46;5&#37; of CNB&#44; 7&#37; of benign surgical biopsies&#44; and 26&#37; of resections for carcinoma&#46;<a class="elsevierStyleCrossRefs" href="#bb0075"><span class="elsevierStyleSup">15&#8211;18</span></a> Its RR is low &#40;1&#46;5&#8211;1&#46;8&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a></p><p id="p0065" class="elsevierStylePara elsevierViewall">The radial scar and complex sclerosing lesion may be associated with epithelial proliferation without atypia&#44; ADH&#44; and carcinoma in situ&#44; ductal&#44; or lobular&#46; In surgical resections&#44; carcinoma can be detected in 10&#37; of cases &#40;0&#37;&#8211;25&#37;&#41;&#46; Lesions that present atypia must be surgically removed&#46; However&#44; open excision &#40;OE&#41; may not be mandatory in lesions without atypia&#44; in which the radiological image agrees with the diagnosis by CNB or VAB&#44; if the radiological target lesion has largely been removed by VAB or VAE&#46;<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Sclerosing adenosis&#44; atypical apocrine adenosis&#44; and microglandular adenosis</span><p id="p0070" class="elsevierStylePara elsevierViewall">Sclerosing adenosis &#40;SA&#41; is a benign lesion showing the proliferation of small acini with abundant myoepithelial cells and fibrous stroma &#40;<a class="elsevierStyleCrossRef" href="#f0005">Fig&#46; 1</a>D&#41;&#46; It is associated with a low RR &#40;2&#46;2&#41;&#44; like other proliferative lesions without atypia&#46;<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a></p><p id="p0075" class="elsevierStylePara elsevierViewall">SA with apocrine change &#40;apocrine adenosis&#41; may present atypia &#40;<a class="elsevierStyleCrossRef" href="#f0010">Fig&#46; 2</a>A&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a></p><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0080" class="elsevierStylePara elsevierViewall">Atypical apocrine adenosis &#40;AAA&#41; preferentially affects postmenopausal women&#46;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> The differential diagnosis of AAA should be established with apocrine DCIS&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">Microglandular adenosis &#40;MGA&#41; is an extremely rare proliferative lesion characterized by rounded glandular structures lined by cells containing eosinophilic secretions &#40;<a class="elsevierStyleCrossRef" href="#f0010">Fig&#46; 2</a>B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> It presents an IHC profile characterized by the absence of the myoepithelial layer&#44; positivity with S100&#44; and triple-negative immunophenotype &#40;<a class="elsevierStyleCrossRef" href="#f0010">Fig&#46; 2</a>D&#41;&#46; Laminin and collagen IV stains demonstrate the presence of basal lamina&#46; Atypical MGA shows a more complex architecture with cytological atypia &#40;<a class="elsevierStyleCrossRef" href="#f0010">Fig&#46; 2</a>C&#41;&#46; Twenty-five per cent of atypical MGA are associated with carcinoma&#46; It is related to triple-negative breast cancer&#46;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> The lesion must be surgically removed when atypical MGA is diagnosed in CNB&#47;VAB&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Non-invasive papillary lesions</span><p id="p0090" class="elsevierStylePara elsevierViewall">Papillary lesions can be central or peripheral&#44; solitary&#44; or multiple &#40;<a class="elsevierStyleCrossRef" href="#f0015">Fig&#46; 3</a>&#41;&#46; The lesions may be asymptomatic or palpable and produce bloody secretion&#46; They are histologically characterized by intraductal epithelial proliferation associated with fibrovascular cores&#46; They can be benign&#44; atypical&#44; or harbor non-invasive carcinomas&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> A double epithelial and myoepithelial layer lines benign papillomas &#40;<a class="elsevierStyleCrossRef" href="#f0015">Fig&#46; 3</a>B&#41;&#46; Papilloma may present areas of ADH or foci of low-grade DCIS&#46; Their size differentiates these&#59; less than 3&#8239;mm for ADH and greater than 3&#8239;mm for DCIS&#46;</p><elsevierMultimedia ident="f0015"></elsevierMultimedia><p id="p0095" class="elsevierStylePara elsevierViewall">The IHC study is essential in diagnosing benign intraductal papilloma&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> Myoepithelial stains show positivity in the papillae and ductal layer &#40;<a class="elsevierStyleCrossRef" href="#f0015">Fig&#46; 3</a>C&#41;&#46;</p><p id="p0100" class="elsevierStylePara elsevierViewall">The RR of carcinoma associated with central and peripheral papilloma is 2 and 3&#44; respectively&#46; The RR associated with papilloma with atypia is 7&#46;5&#46;<a class="elsevierStyleCrossRefs" href="#bb0140"><span class="elsevierStyleSup">28&#8211;31</span></a><span class="elsevierStyleSup">&#46;</span> Papillomas without atypia&#44; diagnosed by CNB&#44; present a higher risk lesion at surgery in less than 10&#37; of cases&#46; Therefore&#44; the surgical indication must be individualized based on the patient&#39;s characteristics&#44; image&#44; and lesion size&#46; After a diagnosis by CNB&#47;VAB&#44; it is considered acceptable to carry out radiological follow-up if the target image has been removed&#46; However&#44; papillary lesions with ADH present a higher risk lesion with a high frequency &#40;&#62;<span class="elsevierStyleHsp" style=""></span>50&#37;&#41;&#44; for which OE is indicated&#46;<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Atypical ductal hyperplasia</span><p id="p0105" class="elsevierStylePara elsevierViewall">ADH is diagnosed histologically based on cytological&#44; architectural&#44; and quantitative criteria &#40;<a class="elsevierStyleCrossRef" href="#f0020">Fig&#46; 4</a>A and B&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bb0160"><span class="elsevierStyleSup">32&#8211;35</span></a> The cytology and architecture of ADH are like those of low-grade DCIS&#46; The difference between ADH and low-grade DCIS is quantitative&#46; Atypical proliferative lesions that affect up to 2 lobular units or measure up to 2&#8239;mm are diagnosed as ADH&#44; and larger lesions are diagnosed as low-grade DCIS&#46; The WHO recommends a conservative diagnosis&#44; favoring a diagnosis of ADH in small lesions&#44; especially when diagnosed in CNB&#46;<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> These quantitative criteria are orientative and arbitrary&#46;</p><elsevierMultimedia ident="f0020"></elsevierMultimedia><p id="p0110" class="elsevierStylePara elsevierViewall">ADH presents genetic alterations like those described in low-grade DCIS&#44; low-grade invasive ductal carcinoma&#44; and lobular neoplasia &#40;LN&#41;&#46; These include losses of 16q and 17p and gains of 1q&#46;<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a></p><p id="p0115" class="elsevierStylePara elsevierViewall">ADH represents 5&#37;&#8211;10&#37; of benign breast biopsies&#59; the RR of breast cancer for this population is 3&#8211;5 times&#59; the absolute risk of breast cancer is 15&#37; &#40;3&#46;7&#37;&#8211;30&#37;&#41;&#46; The risk affects both breasts&#46; The mean latency time after the diagnosis of ADH in a surgical biopsy until the development of breast carcinoma is 8&#46;3&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a></p><p id="p0120" class="elsevierStylePara elsevierViewall">The histological diagnosis of ADH must be established by pathologists who are experts in breast diseases&#46;<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a></p><p id="p0125" class="elsevierStylePara elsevierViewall">Some cases present histological features that fall between ADH and low-grade DCIS&#59; these cases are designated ADH bordering on DCIS &#40;ADH-BD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bb0180"><span class="elsevierStyleSup">36&#8211;38</span></a></p><p id="p0130" class="elsevierStylePara elsevierViewall">OE is recommended after a diagnosis of ADH on CNB&#47;VAB&#46;<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a></p><p id="p0135" class="elsevierStylePara elsevierViewall">In small lesions&#44; less than 15&#8239;mm&#44; VAE could be considered&#46;<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Columnar cell lesions and flat epithelial atypia</span><p id="p0140" class="elsevierStylePara elsevierViewall">Lesions with columnar cells frequently contain secretions and microcalcifications &#40;<a class="elsevierStyleCrossRef" href="#f0020">Fig&#46; 4</a>C&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a> A subgroup of these lesions&#44; flat epithelial atypia &#40;FEA&#41;&#44; shows low-grade nuclear atypia but no significant intraluminal proliferation characteristics in ADH &#40;<a class="elsevierStyleCrossRef" href="#f0020">Fig&#46; 4</a>D&#41;&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">FEA is detected in up to 10&#37; of CNB and 2&#46;4&#37; of surgical biopsies&#46; The RR of carcinoma is low &#40;2&#46;04&#41;&#46; It is frequently associated with ADH &#40;46&#37;&#41;&#46; The detection of DCIS in surgical biopsy is 9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a></p><p id="p0150" class="elsevierStylePara elsevierViewall">After a diagnosis of FEA on CNB&#44; resection with VAB is recommended&#44; and radiological follow-up if 90&#37; or more of the lesion has been removed&#46;<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a></p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Lobular neoplasia</span><p id="p0155" class="elsevierStylePara elsevierViewall">The term LN encompasses atypical lobular hyperplasia &#40;ALH&#41; and LCIS&#46;<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a></p><p id="p0160" class="elsevierStylePara elsevierViewall">LCIS is not a direct precursor of invasive breast cancer but instead behaves as a risk factor&#46;</p><p id="p0165" class="elsevierStylePara elsevierViewall">LN is diagnosed with greater prevalence in premenopausal women&#46; It is frequently a multifocal and multicentric &#40;50&#37;&#41; and bilateral &#40;30&#37;&#41; disease&#46; LN does not present characteristic images&#46; It can be associated with other lesions &#40;SA&#44; radial scar&#44; and columnar cell lesions&#41;&#46; Microcalcifications occur in 23&#37;&#8211;60&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a></p><p id="p0170" class="elsevierStylePara elsevierViewall">Classic LCIS presents a uniform population of cells with rounded and eccentric nuclei that occupy more than 50&#37; of the lumen of the mammary acini&#44; causing them to distend &#40;<a class="elsevierStyleCrossRef" href="#f0025">Fig&#46; 5</a>A&#41;&#46; Lesions of smaller volumes are classified as ALH&#46;</p><elsevierMultimedia ident="f0025"></elsevierMultimedia><p id="p0175" class="elsevierStylePara elsevierViewall">The IHC study of LCIS shows a loss of E-cadherin&#44; with the absence or a marked decrease in cytoplasmic membrane staining &#40;<a class="elsevierStyleCrossRef" href="#f0025">Fig&#46; 5</a>B&#41;&#59; up to 10&#37; of the cases may show aberrant expression of E-cadherin&#46; Beta-catenin and p120 can also be helpful in defining the immunophenotype in selected cases&#46;</p><p id="p0180" class="elsevierStylePara elsevierViewall">Molecular studies of LN most frequently show a loss of 16q and a gain of 1q&#46; The CDH1 gene mutation&#44; located at 16q 22&#46;1&#44; is related to the loss of expression of E-cadherin&#44; a suppressor gene associated with cell adhesion&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a></p><p id="p0185" class="elsevierStylePara elsevierViewall">Patients with LN have a higher risk of developing invasive breast cancer&#44; lobular or non-special &#40;ductal&#41; type&#46; The RR is 4&#8211;5 times in HLA and 8&#8211;10 in LCIS&#46; Invasive carcinoma develops with a low prevalence over a long period &#40;15&#8211;30&#8239;years&#41;&#46; The breast cancer mortality rate is low after the diagnosis of LCIS &#40;1&#46;1&#37; after 12&#8239;years&#41;&#46; The risk of invasive cancer affects both breasts but is higher for the ipsilateral breast&#46; The absolute risk at 20&#8239;years is approximately 20&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a></p><p id="p0190" class="elsevierStylePara elsevierViewall">After a diagnosis of CNB&#47;VAB&#44; observation is recommended in most patients rather than surgery&#46;<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a> However&#44; if there is radiological&#8211;pathological discordance&#44; OE or VAE is advised&#46;</p><p id="p0195" class="elsevierStylePara elsevierViewall">Histological variants of LCIS require special mention&#58; florid LCIS &#40;FLCIS&#41; and pleomorphic LCIS &#40;PLCIS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0205"><span class="elsevierStyleSup">41&#8211;46</span></a></p><p id="p0200" class="elsevierStylePara elsevierViewall">FCLIS presents low nuclear atypia but causes significant acini distention and may show necrosis &#40;<a class="elsevierStyleCrossRef" href="#f0025">Fig&#46; 5</a>C&#41;&#46;</p><p id="p0205" class="elsevierStylePara elsevierViewall">PLCIS is characterized by marked nuclear atypia&#46; They frequently present necrosis and resemble DCIS with comedonecrosis &#40;<a class="elsevierStyleCrossRef" href="#f0025">Fig&#46; 5</a>D&#41;&#46; With some frequency&#44; it can be HER2 positive&#46;<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0215"><span class="elsevierStyleSup">43&#8211;46</span></a></p><p id="p0210" class="elsevierStylePara elsevierViewall">LCIS variants &#40;FLCIS and PLCIS&#41; usually present target lesions&#44; generally microcalcifications&#44; on imaging&#46; After diagnosis by CNB&#44; surgical excision is recommended due to the frequent presence of a higher-grade lesion in 33&#37;&#8211;38&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a></p><p id="p0215" class="elsevierStylePara elsevierViewall">In the case of PLCIS&#44; surgical management like that of DCIS is recommended&#44; and the margins should be free of tumor&#46;<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a> Radiotherapy is advised after conservative surgery in PLCIS due to its similarity to high-grade DCIS&#46;<a class="elsevierStyleCrossRefs" href="#bb0220"><span class="elsevierStyleSup">44&#8211;46</span></a></p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">General principles for the management of proliferative lesions at risk for breast cancer &#40;<a class="elsevierStyleCrossRefs" href="#t0010">Tables 2 and 3</a>&#41;<a class="elsevierStyleCrossRefs" href="#bb0040"><span class="elsevierStyleSup">8&#8211;11</span></a></span><p id="p0220" class="elsevierStylePara elsevierViewall">The pathologist plays a fundamental role in the histological diagnosis of breast lesions and participates in management decisions with radiologists and surgeons&#46; For this&#44; the pathologist must have complete information on the clinical symptoms and the findings of the imaging techniques&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0225" class="elsevierStylePara elsevierViewall">Minimally invasive biopsies &#40;CNB and VAB&#41; are the procedure of choice for the diagnosis of palpable and non-palpable breast lesions&#46; For the histological classification&#44; it may be helpful to use the diagnostic categories proposed by the Royal College of Pathologists of the United Kingdom &#40;<a class="elsevierStyleCrossRef" href="#t0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a></p><p id="p0230" class="elsevierStylePara elsevierViewall">OE is generally recommended for ADH lesions because the underestimation rates should be below 5&#37; for invasive carcinoma and below 10&#37; for DCIS&#46; However&#44; VAE is being implemented for small lesions&#46;</p><p id="p0235" class="elsevierStylePara elsevierViewall">Radiological follow-up is recommended after removal with VAB or VAE in B3 lesions without atypia&#46;</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Funding</span><p id="p0240" class="elsevierStylePara elsevierViewall">No funding has been used for this review&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Ethical committee approval</span><p id="p0245" class="elsevierStylePara elsevierViewall">The characteristics of the review exempt it from ethics committee approval&#46;</p></span></span>"
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          "identificador" => "xres2289970"
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          "identificador" => "s0005"
          "titulo" => "Introduction"
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          "identificador" => "s0010"
          "titulo" => "Usual ductal hyperplasia &#40;UDH&#41;"
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        6 => array:2 [
          "identificador" => "s0015"
          "titulo" => "Radial scar &#40;&#60;1&#8239;cm&#41; and complex sclerosing lesion &#40;&#62;1&#8239;cm&#41;"
        ]
        7 => array:2 [
          "identificador" => "s0020"
          "titulo" => "Sclerosing adenosis&#44; atypical apocrine adenosis&#44; and microglandular adenosis"
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        8 => array:2 [
          "identificador" => "s0025"
          "titulo" => "Non-invasive papillary lesions"
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        9 => array:2 [
          "identificador" => "s0030"
          "titulo" => "Atypical ductal hyperplasia"
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        10 => array:2 [
          "identificador" => "s0035"
          "titulo" => "Columnar cell lesions and flat epithelial atypia"
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        11 => array:2 [
          "identificador" => "s0040"
          "titulo" => "Lobular neoplasia"
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        12 => array:2 [
          "identificador" => "s0045"
          "titulo" => "General principles for the management of proliferative lesions at risk for breast cancer &#40;Tables 2 and 3&#41;"
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          "titulo" => "Funding"
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            0 => "Risk lesions"
            1 => "Breast neoplasm"
            2 => "Carcinoma"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Lesiones de riesgo"
            1 => "Neoplasias de mama"
            2 => "Carcinoma"
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        "titulo" => "Abstract"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">Histological lesions of risk of breast cancer are proliferative epithelial lesions associated with a higher incidence of breast cancer&#46; The magnitude of the risk is related to the presence of epithelial atypia&#46; Lesions with atypical hyperplasia have a relative risk of cancer 4 times higher than the control population&#46; Proliferative epithelial lesions present diverse histological characteristics and must be appropriately classified&#46; They include usual ductal hyperplasia&#44; radial scar and complex sclerosing lesions&#44; sclerosing adenosis&#44; apocrine adenosis&#44; microglandular adenosis&#44; papillary lesions&#44; atypical ductal hyperplasia&#44; flat epithelial atypia&#44; lobular neoplasia&#46; They propose the differential diagnosis with ductal carcinoma in situ and invasive carcinoma&#46; When risk lesions type B3 are diagnosed in needle-core and vacuum-assisted biopsies&#44; the underestimation rates for invasive carcinoma should be below 5&#37; and below 10&#37; for ductal carcinoma in situ&#46; In this review&#44; we describe the clinical and histological aspects of the different entities and discuss the possible management options depending on the diagnostic category and the lesion size&#46; Correct management requires close collaboration between surgeons&#44; radiologists&#44; and pathologists&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Las lesiones histol&#243;gicas de riesgo de c&#225;ncer de mama son lesiones epiteliales proliferativas asociadas a una mayor incidencia de c&#225;ncer de mama&#46; La magnitud del riesgo est&#225; relacionada con la presencia de atipia epitelial&#46; Las lesiones con hiperplasia at&#237;pica tienen un riesgo relativo de c&#225;ncer cuatro veces mayor que la poblaci&#243;n control&#46; Las lesiones epiteliales proliferativas presentan caracter&#237;sticas histol&#243;gicas diversas y deben ser clasificadas adecuadamente&#46; Incluyen la hiperplasia ductal usual&#44; la cicatriz radial y lesiones esclerosantes complejas&#44; la adenosis esclerosante&#44; adenosis apocrina&#44; adenosis microglandular&#44; lesiones papilares&#44; hiperplasia ductal at&#237;pica&#44; la atipia epitelial plana y la neoplasia lobulillar&#46; Plantean el diagn&#243;stico diferencial con el carcinoma ductal in situ y con el carcinoma infiltrante&#46; Cuando se diagnostican en biopsias por punci&#243;n y en biopsias asistidas por vac&#237;o lesiones de riesgo tipo B3&#44; la tasa infraestimaci&#243;n de carcinoma infiltrante y carcinoma ductal in situ debe ser inferior a 5&#37; y 10&#37;&#44; respectivamente&#46; En esta revisi&#243;n describimos aspectos cl&#237;nicos e histol&#243;gicos de las distintas entidades y discutimos las posibles opciones de manejo&#44; en funci&#243;n de la categor&#237;a diagn&#243;stica y del tama&#241;o de la lesi&#243;n&#46; El manejo correcto de estas lesiones requiere una estrecha colaboraci&#243;n entre cirujanos&#44; radi&#243;logos y pat&#243;logos&#46;</p></span>"
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Usual ductal hyperplasia showing intraluminal cellular proliferation&#46; The cells are arranged in streams&#44; and they tend to overlap&#46; They delineate irregular-shaped spaces&#46; &#40;B&#41; Radial scar showing a central area of sclerosis and a lobulocentric architecture&#46; &#40;C&#41; Complex sclerosing lesion with irregular acinar proliferation&#44; surrounded by collagenous stroma&#46; &#40;D&#41; Sclerosing adenosis is characterized by the proliferation of epithelial and myoepithelial cells embedded in a collagenous stroma&#46;</p>"
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Atypical apocrine adenosis showing acini lined by cells with pink granular cytoplasms&#46; The nuclei are hyperchromatic and moderately pleomorphic&#46; &#40;B&#41; Microglandular adenosis showing rounded acini containing eosinophilic secretions&#46; &#40;C&#41; Atypical microglandular adenosis shows rounded acini with intraluminal secretions&#46; Some acini are irregular and fused&#46; &#40;D&#41; S100 immunostaining shows diffuse positivity&#46; &#40;For interpretation of the references to color in this figure legend&#44; the reader is referred to the web version of this article&#46;&#41;</p>"
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          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Intraductal papilloma showing branching papillae with fibrovascular cores&#46; &#40;B&#41; A double layer of epithelial and myoepithelial cells lines them&#46; &#40;C&#41; p63 immunostaining shows positive myoepithelial cells&#46; &#40;D&#41; Multiple papillomas occupy distended ductal spaces&#46;</p>"
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          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Atypical ductal hyperplasia shows epithelial cell proliferation&#44; with low-grade nuclear atypia&#44; forming micropapillae and cellular bridges&#46; &#40;B&#41; CK14 immunostaining is limited to the myoepithelial layer and a few foci of usual ductal hyperplasia&#46; &#40;C&#41; Flat epithelial atypia showing distended acini with intraluminal calcifications&#46; &#40;D&#41; The acinus is lined by epithelial cells with overlapping&#44; rounded nuclei&#46;</p>"
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          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Lobular carcinoma in situ&#44; classical type&#44; showing distended acini completely occupied by poorly cohesive&#44; rounded cells&#46; &#40;B&#41; E-cadherin immunostaining with lack of expression in the lobular carcinoma in situ&#46; &#40;C&#41; Lobular carcinoma in situ&#44; florid type&#44; with markedly distended acini and low-grade cellular atypia&#46; &#40;D&#41; Lobular carcinoma in situ&#44; pleomorphic type&#46; The cells are markedly atypical&#44; showing eccentrically located nuclei&#46; Focal necrosis is shown&#46;</p>"
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          "leyenda" => "<p id="sp4040" class="elsevierStyleSimplePara elsevierViewall">RR&#58; relative risk&#46;</p><p id="sp3045" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Dupont and Page&#44;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> London et al&#46;<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> and Hartman et al&#46;<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a></p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Proliferative lesions without atypia&#46; Low risk&#46; RR 1&#46;27&#8211;1&#46;90</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ductal hyperplasia without atypia&#44; usual or florid type&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sclerosing and apocrine adenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lesions with columnar cells&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radial scar and complex sclerosing lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Papillomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Proliferative lesions with atypia&#46; High risk&#46; RR 3&#46;7&#8211;5&#46;9</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atypical ductal hyperplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Flat epithelial atypia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atypical lobular hyperplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Classification of lesions at risk for breast cancer&#46;</p>"
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      6 => array:8 [
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        "etiqueta" => "Table 2"
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          "leyenda" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">FEA&#58; flat epithelial atypia&#59; DCIS&#58; ductal carcinoma in situ&#59; ADH&#58; atypical ductal hyperplasia&#59; LN&#58; lobular neoplasia&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Source&#58; The Royal College of Pathologists of the United Kingdom&#46;<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B1&#58; Normal breast tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indicate the presence of breast epithelium and microcalcifications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B2&#58; Benign lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Include fibroadenoma&#44; fibrocystic changes&#44; sclerosing adenosis&#44; ductal ectasia&#44; and others&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B3&#58; Lesion of uncertain malignant potential&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Benign lesions that may be heterogeneous or associated with a higher risk of malignant lesions&#46; Include ADH&#44; FEA&#44; LN&#44; papillary lesions&#44; radial scar&#44; mucocele-like lesions&#44; and rare lesions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B4&#58; Lesion suspected of malignancy&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Does not allow a definitive diagnosis due to a lack of material or associated artifacts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B5&#58; Malignant lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">If possible&#44; specify the grade and histological type</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B5a&#46; DCIS&#44; malignant papillary lesion&#44; pleomorphic lobular carcinoma situ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B5b&#46; Invasive carcinoma and other malignant tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B5c&#46; Carcinoma cannot be specified if it is in situ or infiltrative&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Diagnostic classification system for core needle biopsies&#46;</p>"
        ]
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        "etiqueta" => "Table 3"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of lesion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atypical ductal hyperplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Open resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Consider VAE in small lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Flat epithelial atypia and columnar cell lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resection with VAB and radiological follow-up if 90&#37; of the target lesion has been removed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radial scar&#47;complex sclerosing lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resection with VAB and radiological follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VAE if needed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Papillary lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After CNB diagnosis of lesions without atypia&#44; complete resection of the target lesion with VAB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Open excision&#47;VAE of lesions with atypia and large papillary lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LCIS and atypical lobular hyperplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After diagnosis with CNB or VAB&#44; radiological follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Open excision&#47;VAE of lesions with radiological-pathological discordance Resection of pleomorphic and florid LCIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Management of risk breast lesions diagnosed by CNB&#47;VAB&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bs0005"
          "bibliografiaReferencia" => array:48 [
            0 => array:3 [
              "identificador" => "bb0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for breast cancer in women with proliferative breast disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;D&#46; Dupont"
                            1 => "D&#46;L&#46; Page"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198501173120303"
                      "Revista" => array:6 [
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                        "volumen" => "312"
                        "paginaInicial" => "146"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3965932"
                            "web" => "Medline"
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              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective study of benign breast disease and the risk of breast cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;J&#46; London"
                            1 => "J&#46;L&#46; Connolly"
                            2 => "S&#46;J&#46; Schnitt"
                            3 => "G&#46;A&#46; Colditz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1992"
                        "volumen" => "267"
                        "paginaInicial" => "941"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1734106"
                            "web" => "Medline"
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              "identificador" => "bb0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benign breast disease and the risk of breast cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;C&#46; Hartman"
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                            2 => "M&#46;H&#46; Frost"
                            3 => "W&#46;L&#46; Lingle"
                            4 => "A&#46;C&#46; Degnim"
                            5 => "K&#46; Ghosh"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa044383"
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                        "tituloSerie" => "N Engl J Med"
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                        "volumen" => "353"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16034008"
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                      "titulo" => "Understanding the premalignant potential of atypical hyperplasia through its natural history&#58; a longitudinal cohort study"
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                        "tituloSerie" => "Cancer Prev Res"
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Original language: English
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