导管内乳头状瘤、扁平上皮异型性、放射性瘢痕、非典型小叶增生和小叶原位癌在历史上被称为高风险病变，并在核心针生物检后常规进行手术切除治疗。这种错误的高风险称呼源于历史文献中报告的恶性升级率高。然而，最近的研究发现，与先前所想的升级率相比，这些发现的升级率要低得多，小于2%。这些发现是由于成像技术的进步、更大孔径的生物检针和强调放射病理一致性所解释的。一致性病变的升级风险低，可以通过放射学和临床监测来管理，而不是手术切除治疗。对于许多这些病变，通过仔细的多学科评估和详细的风险-效益讨论与患者进行手术减弱是可行的。版权所有© 2023 Elsevier Inc.。保留所有权利。

Intraductal papilloma, flat epithelial atypia, radial scar, atypical lobular hyperplasia, and lobular carcinoma in situ have historically been referred to as high-risk lesions and managed with routine surgical excision after diagnosis on core needle biopsy. The misnomer high-risk stems from high rates of upgrade to malignancy reported in historic literature. However, recent studies have found much lower upgrade rates, <2%, than previously thought. These findings are explained by advances in imaging technology, larger-bore biopsy needles, and emphasis on radiology-pathology concordance. Concordant lesions have a low upgrade risk and can be managed with radiographic and clinical surveillance instead of surgical excision. Surgical de-escalation is feasible for many of these lesions with careful multidisciplinary review and a detailed risk-benefit discussion with patients.Copyright © 2023 Elsevier Inc. All rights reserved.