As high-tech breast imaging techniques are increasingly implemented in practice, physicians are detecting more nonpalpable lesions which they think are necessary to be sampled. Currently, the image guided large core biopsy is the preffered method to confirm the diagnosis. 1-10% of core biopsies reveal benign proliferative lesions which pose further dilemmas. Atypical ductal hyperplasia, lobular neoplasia (atypical lobular hyperplasia and lobular carcinoma in situ) and benign papillary lesions are among these benign diseases. Previous studies showed that subsequent excision of these lesions upgrade the diagnosis. Depending on the type of core biopsy diagnosis, in up to half of the patients in situ or invasive carcinoma is found after excisional biopsy. Therefore, it is crucial to identify those benign proliferative diseases who necessitate further excision. The second dilemma is assessing the breast cancer risk in order to provide appropriate counselling. The risk differs depending on the type of lesion, patient’s age and number of proliferative foci. Finally, counselling should include discussion about risk management options. These include measures which facilitate early diagnosis and preventive methods such as tamoxifen, raloxifene and prophylactic mastectomy. Overall, this comprehensive review provides all available evidence about proper management of patients with benign proliferative diseases.

Keywords: breast, proliferative lesion, atypical ductal hyperplasia, lobular neoplasia, papillary lesion