E1308. Standardized Multi-Disciplinary Approach to the Management of Breast Lesions of Uncertain Malignant Potential
  1. Andrew Scrima; University of Wisconsin
  2. Alison Gegios; University of Wisconsin
  3. Ryan Woods; University of Wisconsin
  4. Amy Fowler; University of Wisconsin
  5. Anand Narayan; University of Wisconsin
  6. Mai Elezaby; University of Wisconsin
Breast lesions of Uncertain Malignant Potential (UMP), historically known as high-risk lesions, refer to those with potential risk of upgrade to in situ or invasive carcinoma. This includes lesions that may have been under sampled, and lesions associated with increased lifetime risk of breast cancer. Historically, surgical excision was recommended for all UMP lesions. However, this approach is associated with unnecessary anxiety, healthcare costs, and morbidity from surgical procedures. Growing evidence regarding outcomes of these lesions in the context of improved understanding of individual risk profiles coupled with improved imaging and intervention technologies highlights the need for modification of current breast practices to facilitate more personalized management plans. This exhibit outlines our institution’s evidence-based multidisciplinary guidelines and approach to management of UMP breast lesions that allows for the consistent application of appropriate management recommendations.

Educational Goals / Teaching Points
Define breast lesions of uncertain malignant potential (UMP). Discuss radiologic-pathologic overview and management options of the most common UMP (high-risk) breast lesions and reported risks of upgrade. The breast lesions discussed include Atypical ductal hyperplasia, atypical lobular hyperplasia/Lobular carcinoma in situ, papilloma with/without atypia, flat epithelial atypia, and radial scar/complex sclerosing lesion. Examine current management approaches and challenges. Highlight our institution’s multidisciplinary radiologic-pathologic-surgical correlation process. Provide case examples of management recommendations and follow-up. Discuss future directions including risk assessment tools and supplemental screening plans utilizing multi-institutional data and societal/national guidelines. Discuss the possible role of artificial intelligence.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multidisciplinary, evidence-based, imaging, and clinical findings for breast lesions of uncertain malignant potential (UMP) the that may predict risk of upgrade and hence, guide follow-up recommendations.

Breast lesions of uncertain malignant potential refer to a frequently encountered group of pathologies associated with increased risk of breast cancer. The lack of standardized guidelines on management recommendations across breast imaging radiologists and surgeons leads to variation in patient care. A Multidisciplinary approach to determine the individual risk and appropriate follow up recommendations of these lesions reduces unnecessary anxiety, health care costs and patient morbidity.