Core needle biopsy of benign, borderline and in-situ problematic lesions of the breast: Diagnosis, differential diagnosis and immunohistochemistry

Ann Diagn Pathol. 2019 Dec;43:151407. doi: 10.1016/j.anndiagpath.2019.151407. Epub 2019 Sep 3.


Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.

Keywords: Atypia; Borderline breast lesions; Breast pathology; Core needle biopsy.

Publication types

  • Review

MeSH terms

  • Adult
  • Aftercare
  • Aged
  • Aged, 80 and over
  • Biopsy, Large-Core Needle / standards*
  • Breast / pathology*
  • Breast / ultrastructure
  • Breast Diseases / metabolism
  • Breast Diseases / pathology*
  • Breast Neoplasms / metabolism
  • Breast Neoplasms / pathology*
  • Breast Neoplasms / ultrastructure
  • Carcinoma, Intraductal, Noninfiltrating / metabolism
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Carcinoma, Intraductal, Noninfiltrating / surgery
  • Diagnosis, Differential
  • Female
  • Fibrocystic Breast Disease / pathology
  • Health Status Indicators
  • Humans
  • Hyperplasia / pathology
  • Immunohistochemistry / methods*
  • Middle Aged
  • Observer Variation
  • Pathologists / ethics
  • Prognosis