{
  "abstract": "Borderline breast lesions (B3 lesions, also termed lesions of uncertain malignant potential or high-risk lesions) represent a heterogeneous group of entities associated with variable risks of malignancy. While the management of screen-detected B3 lesions has become increasingly standardised, no dedicated international recommendations exist for symptomatic B3 lesions, despite them posing a distinct clinical challenge. Symptomatic lesions differ from screen-detected lesions in their mode of presentation, lesion characteristics, biopsy techniques, and diagnostic objectives; consequently, management strategies derived from screening populations may not be directly applicable. This review summarises the current evidence and proposes a pragmatic management framework for B3 lesions encountered in the symptomatic setting (defined as those presenting with breast symptoms outside population-based screening programmes). This is particularly relevant for patients under 50 years of age, where the primary objective is to exclude malignancy at the index site rather than solely to stratify long-term cancer risk. Clinical-radiological-pathological concordance and multidisciplinary assessment are central to management decisions. Lesions presenting as palpable abnormalities (which are typically larger) or those demonstrating radiological-pathological discordance warrant a lower threshold for additional sampling or excision. Conversely, selected concordant lesions without atypia may be managed conservatively following adequate sampling. The long-term cancer risk associated with epithelial atypia should also be considered with subsequent risk-based surveillance implemented where appropriate. Overall, management requires a risk-adapted, multidisciplinary approach integrating pathological, radiological, and clinical factors alongside patient symptoms and quality-of-life considerations. Given the limited evidence, current recommendations rely on expert consensus and a proposed practical framework. They underscore the need for large-scale, high-quality studies with long-term follow-up to establish formal clinical guidelines.\n\nSupplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s00428-026-04672-2.",
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  "affiliations": [
    "School of Medicine, University of Nottingham, Nottingham, UK",
    "Department of Pathology, National Reference Laboratory and Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates",
    "Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK",
    "Department of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK",
    "Department of Pathology, University Hospitals Leuven, KU-Leuven, Herbstreit 49, Leuven, 3000 Belgium",
    "Discipline of Pathology, University of Galway, Galway, Ireland",
    "Breast Radiologist, Breast Unit, University of Galway, Galway, Ireland",
    "Oncoplastic Breast Surgery Department, The Royal Wolverhampton NHS Trust, Wolverhampton, UK",
    "Reference Centers Mammography, Münster and Berlin, Berlin, Germany",
    "Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria",
    "Oncoplastic Breast Surgery Department, Broomfield Hospital, Mid and South Essex NHS Trust, Chelmsford, England",
    "Department of Histopathology, Addenbrookes Hospital, Cambridge, UK",
    "Department of Pathology, University Hospitals of Derby and Burton, Derby, UK",
    "Department of Surgery, NYULangone Health Medical Center, New York, NY USA",
    "Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates",
    "Radiology Department, Northwick Park Hospital & Royal Free Breast Screening, Harrow, Middlesex UK",
    "Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland",
    "Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands",
    "Department of Pathology, Albert Szent-Györgyi Faculty of Medicine, University of Szeged, Bács-Kiskun County Teaching Hospital, Szeged, Kecskemét, Hungary",
    "Department of Biomedical and Neuromotor Sciences, Unit of Pathology at Bellaria Hospital, University of Bologna, Bologna, 40139 Italy",
    "Department of Pathology, Erasmus MC, Rotterdam, The Netherlands",
    "Department of Cellular Pathology, Barts Health NHS Trust, Queen Mary University of London, London, UK",
    "Department of Pathology, Liverpool University Hospitals Group, Liverpool, UK",
    "Pathology Department & Epithelial Stem Cells and Cancer Lab, CRCM, Inserm, CNRS, Institut Paoli-Calmettes, Aix-Marseille Univ, Equipe labellisée LIGUE contre le cancer, Marseille, France",
    "Research Department of Pathology, University College London, London, UK",
    "Department of Pathology, Medical University of Vienna, Vienna, Austria",
    "Department of Medical Sciences, University of Turin, Turin, Italy",
    "Surgical Department Breast Oncoplastic Unit, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates",
    "Department of Pathology, UCLouvain, Cliniques universitaires Saint-Luc, Brussels, Belgium",
    "Luma Medical Centre, Royal Square Medical Centre, Singapore, Singapore",
    "Department of Histopathology, School of Medicine, Irish National Breast Screening Programme, St. Vincent’s University Hospital, University College Dublin, Dublin, Ireland",
    "School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 31,
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      "name": "Giuseppe Floris"
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      "name": "Grace Callagy"
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      "name": "Nisha Sharma"
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      "name": "Muna A. Abuhejleh"
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      "name": "Gábor Cserni"
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      "name": "Maria Pia Foschini"
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      "name": "Carolien H.M. van Deurzen"
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      "name": "Cecily Quinn"
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  "doi": "10.1007/s00428-026-04672-2",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13714129/",
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  "licence_label": "CC BY 4.0",
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      "heading",
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  "pmcid": "PMC13714129",
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  "published": "2026-08-10",
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      "field": "medicine",
      "origin": "openalex:2734|Breast Lesions and Carcinomas",
      "subfield": "general"
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  "title": "Management of high-risk (B3) breast lesions in symptomatic practice: evidence review and practical recommendations for multidisciplinary care",
  "title_text": "Management of high-risk (B3) breast lesions in symptomatic practice: evidence review and practical recommendations for multidisciplinary care",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:41Z",
  "url": "https://research.draconitic.com/paper/ebrnqqc24yr53",
  "venue": "Virchows Archiv",
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