The high-risk patient enigma
The ECR Master Class 2018 focused on high risk lesions. Dr. Gábor Forrai’s (Budapest, HU) talk was about breast high risk lesions, including their pathologic and radiologic features. He underlined the importance of the preoperative multidisciplinary meeting as a necessary step in the flow-chart of high risk lesions, considering the First International Consensus Conference in Zurich in 2016 as reference for many recommendations for therapy and follow-up.
Dr. Ritse Mann (Nijmegen, NL) showed how MRI features of high risk lesions can be helpful and challenging at the same time. The absence of MRI enhancement is rarely correlated with malignancy of the lesion, especially for papilloma and radial scar but, as negative predictive value (NPV), MRI is less trustable for Lobular Neoplasia and Atypical ductal hyperplasia (ADH).
We can assume that, according to the increasing concerns about overdiagnosis and subsequent overtreatment, the approach to B3 lesions needs to be changed. Dr. Vinnicombe (Dundee, GB) overviewed the minimally invasive methods of treatment used for these lesions. Various techniques are available, including large-core vacuum-assisted devices. These approaches to management of B3 lesions are cost-effective, well tolerated and can be considered a valuable option of treatment in selected cases of high-risk lesions. However, oncological safety must be warranted trough a good radio-pathological concordance.
Listen to the lecture via ECR Online (http://ecronline.myesr.org/ecr2018/)