Objective: This article focuses on four high-risk lesions: lobular neoplasia, benign papilloma, radial scar, and flat epithelial atypia. Controversies exist in the management after core biopsy of each of these lesions--whether to perform immediate surgical excision so as not to miss an associated malignancy or imaging follow-up because concomitant malignancy is low. This review is staged in two parts per lesion. The first is from data gathered during the last two American Roentgen Ray Society annual meetings from the audience response system querying practice management styles per diagnostic lesion. The second part is a brief review of selected articles recommending either follow-up or surgery. The strengths and weaknesses of each article are discussed.
Conclusion: Our opinion is that neither recommendation, surgical excision or follow-up, is well substantiated in the literature and that our ignorance is not serving the needs of women worldwide. The time is now for a prospective trial.