E1853. Out with the Old, In with the New: Benign with Upgrade Potential (BWUP) Lesions of the Breast
Authors
Abeer Abdelhafez;
The University of Texas Health and Science Center
Charisma Desai ;
The University of Texas Health and Science Center
Harnoor Singh;
The University of Texas Health and Science Center
Naik Udit K;
The University of Texas Health and Science Center
Niloofar Karbasian;
The University of Texas Health and Science Center
Steven Lee;
The University of Texas Health and Science Center
Claudia Cotes ;
The University of Texas Health and Science Center
Background
High-risk breast lesions have been extensively reviewed given their variable imaging features, presentations, and recommended treatment. However, their imaging follow-up and treatment have remained controversial, with different approaches varying amongst institutions. Recently, at the Society of Breast Imaging symposium, the term "benign with upgrade potential" (BWUP) was introduced to clarify and standardize these variations. The purpose of this exhibit is to familiarize the learner with this new term and provide highlights of this new classification, as some of the lesions previously considered high risk have been removed in this new term. All changes take time to get adjusted to, and it is important for radiologists to be up to date with new classifications.
Educational Goals / Teaching Points
This exhibit will cover the following. Definition of previous term high-risk breast lesions (HRBLs). New classification of BWUP lesions and difference with previous definition. Clinical and radiological significance of proper identification and sampling of BWUP lesions.
Review of imaging features of BWUP lesions. Review of the multidisciplinary approach of management BWUP lesions. Follow up of BWUP lesions.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Key points in this exhibit are as follows: peripheral duct papilloma and Radial Scar: Why are they removed from the classification, imaging features and current approach definition, presentation and imaging features (mammogram, ultrasound, MRI) of BWUP lesions: Lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), phyllodes tumor, flat epithelial atypia (FEA), importance of proper sampling and radiologic/pathologic concordance, outline the breast radiologist role in proper lesion identification, selection of sampling target and biopsy modality guidance technique, determine radiological-pathological concordance, and proper follow-up.
Conclusion
High-risk lesions of the breast have been well documented in the literature, however, their management and follow up has remained controversial and varies within institutions. At the most recent Society of Breast Imaging symposium, the term has been updated to BWUP, indicating that these lesions are benign by definition but in the appropriate setting can have an increased probability to upgrade into malignancies. Keeping radiologists up to date with the most current terms in the breast imaging is important to ensure patients receive the most accurate, evidence-based follow up and treatment of these lesions.
