经皮活检标本中经常会遇到乳腺的高危病变。虽然这些病变是良性的，但由于它们有可能升级为恶性肿瘤，因此历来接受手术切除。然而，有新的证据表明，应考虑采取量身定制的管理方法，以减少对这些病变的过度治疗。扁平上皮异型性（FEA）和非典型导管增生（ADH）是两种最常见的高危病变。 FEA 已被证明具有相对较低的恶性肿瘤进展率，一些指南现在建议在特定病例中进行观察而不是常规切除。如果目标病变很小且在活检时完全切除，并且没有潜在的危险因素（例如乳腺癌病史或基因突变或并发 ADH），则选择性观察可能是合理的。在所有高危病变中，ADH 的潜在恶性升级率最高。大多数协会指南继续建议手术切除该病变。最近，一些文献表明，活检时完全切除的 ADH 病变，涉及有限的病灶（少于两个或三个），无坏死或明显的异型性，表现为一小群乳房 X 光检查钙化，或在 MRI 上显示无增强。合理观察。最终，所有高风险病变的管理必须基于多学科方法，考虑所有患者、放射学、临床和组织病理学因素。 ©RSNA，2023 本文的测验问题可在补充材料中找到。

High-risk lesions of the breast are frequently encountered in percutaneous biopsy specimens. While benign, these lesions have historically undergone surgical excision due to their potential to be upgraded to malignancy. However, there is emerging evidence that a tailored management approach should be considered to reduce overtreatment of these lesions. Flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) are two of the most commonly encountered high-risk lesions. FEA has been shown to have a relatively low rate of progression to malignancy, and some guidelines are now recommending observation over routine excision in select cases. Selective observation may be reasonable in cases where the target lesion is small and completely removed at biopsy and when there are no underlying risk factors, such as a history of breast cancer or genetic mutation or concurrent ADH. ADH has the highest potential upgrade rate to malignancy of all the high-risk lesions. Most society guidelines continue to recommend surgical excision of this lesion. More recently, some literature suggests that ADH lesions that appear completely removed at biopsy, involve limited foci (less than two or three) with no necrosis or significant atypia, manifest as a small group of mammographic calcifications, or demonstrate no enhancement at MRI may be reasonable for observation. Ultimately, management of all high-risk lesions must be based on a multidisciplinary approach that considers all patient, radiologic, clinical, and histopathologic factors. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.