Nonsurgical Management of High-Risk Lesions

Breast lesions that fall into the B3 category are the subject of a great deal of interest, partly because of their uncertain malignant potential but also due to the lack of clear guidance regarding their assessment and management. During the last decade, several studies have been conducted covering this heterogeneous group that resulted in many guidelines being published across the world proposing different management strategies based on the current evidence. Traditionally, a surgical diagnostic biopsy was required to obtain a representative sample and ensure there was no coexistent malignancy followed by an open surgical excision. However, new evidence has led to VAE being accepted as a valid, more conservative, and cost-effective alternative to the traditional surgical excision with good patient acceptance. VAE has proven to safely address the overtreatment issue associated with these high-risk lesions and simultaneously reduce the morbidity for patients without detriment to oncological outcomes. Overall, these lesions associated with long-term moderate-to-high risk of development of malignancy should be managed and followed up as per updated national guidance, with VAE becoming a standard practice across most breast units in the United Kingdom and Europe.