Reevaluating Surgical Necessity for Certain Breast Lesions Based on Recent Research

Recent findings from researchers at King's College London suggest that surgical removal may not always be necessary for specific types of benign breast lesions detected during routine screening. Traditionally, women diagnosed with radial scars, complex sclerosing lesions (RS/CSL), or papillary lesions—when these do not exhibit abnormal cellular features—undergo procedures like vacuum-assisted excision (VAE) for further testing. However, the new evidence indicates that many of these cases could be managed safely through careful monitoring with regular mammographic surveillance, thereby avoiding invasive procedures.

The study, published in Histopathology, analyzed outcomes from cases between 2017 and 2023 at King's College Hospital. It was found that only 1% of women with RS/CSL and 4% with papillary lesions without atypia were subsequently diagnosed with cancer at the biopsy site. These low rates suggest a significant opportunity to reduce unnecessary surgeries, especially for RS/CSL, by adopting a non-invasive observation approach.

Dr. Kalnisha Naidoo, senior author and adjunct senior lecturer, emphasized that these results could lead to less invasive care models for a subset of patients, which would improve overall treatment experiences and resource utilization. She further noted that although the findings are promising for RS/CSL, more research is needed to understand the risks associated with papillary lesions, which appear to carry a higher potential for malignancy even without atypia.

The study highlights the importance of uniform reporting standards across the NHS Breast Screening Programme, as current variations hinder the development of consistent guidelines. Dr. Amy Llewellyn, a histopathology registrar involved in the study, advocates for evidence-based guidelines that could help reduce unnecessary excisions and improve patient outcomes.

While these findings pave the way for more conservative management strategies, clinicians are encouraged to consider individual patient factors and stay updated with ongoing research to balance cancer detection with minimizing overtreatment.