Your Breast Pathology Report: Benign Breast Conditions

Learn about some of the medical terms in a pathology report that includes benign (noncancerous) breast conditions.

Types of breast biopsies

A biopsy is a procedure that removes small pieces of tissue so they can be examined under a microscope or tested. A breast biopsy can be done by:  

• Needle biopsy, where a hollow needle is used to remove samples from an abnormal area in your breast.
• Incisional biopsy, a type of surgical biopsy in which only part of an abnormal area is removed.
• Excisional biopsy, a type of surgical biopsy that removes the entire abnormal area, often with some of the surrounding normal tissue. It is much like a lumpectomy, a type of breast-conserving surgery.

After biopsy samples are collected from your breast, they are studied by a pathologist, a doctor who specializes in diagnosing and classifying disease. After testing the samples, the pathologist creates a pathology report on what was found. Your doctors can use this report to help manage your care.

Terms describing benign (noncancerous) changes

Some of the terms you might see in your pathology report include:

• Adenosis
• Sclerosing adenosis
• Apocrine metaplasia
• Cysts
• Columnar cell change
• Columnar cell hyperplasia
• Collagenous spherulosis
• Duct ectasia
• Columnar alteration with prominent apical snouts and secretions (CAPSS)
• Papillomatosis
• Fibrocystic changes

All of these are benign changes. These conditions generally do not need to be treated unless they’re causing bothersome symptoms. Most of these conditions do not affect future breast cancer risk.

More information about many of these can be found in Noncancerous Breast Conditions.

Fat necrosis

Fat necrosis is a benign condition that is not linked to cancer risk. It is most often caused by trauma (injury) to the breast. It can also develop after breast surgery, radiation treatment, or for unknown reasons.

Usual ductal hyperplasia (UDH)

UDH, also called hyperplasia of the usual type or ductal hyperplasia without atypia, is a common benign breast change. It means there is an overgrowth of cells lining the milk ducts (tiny tubes) in the breast, but the cells look very close to normal.

UDH does not need to be treated, although it appears to be linked with a slightly increased risk of getting breast cancer in the future.

Radial scar or complex sclerosing lesion

Radial scar and complex sclerosing lesion are terms for a benign finding that looks like a scar when seen under a microscope, although it is not a scar. 

If radial scars are seen after an excisional biopsy, usually no further action is needed.

If they are found on a needle biopsy:

• Watching the area with imaging tests might be recommended if it is small and is removed entirely by the needle biopsy, or if it is unrelated to what was seen on the mammogram. This is to make sure the area is not growing.
• Removing more tissue might be recommended for lesions that are larger or not removed entirely by the needle biopsy because sometimes radial scars are found near something more serious that might need to be treated.

If your report mentions radial scars, talk with your doctor about what is best in your case.

Papilloma or intraductal papilloma

An intraductal papilloma is a type of benign growth within a milk duct. It might cause symptoms like nipple discharge or a breast lump, or it might show up on a mammogram. Papillomas can occur by themselves (solitary papillomas) or in a group (multiple papillomas).

Papillomas generally aren’t a concern unless they contain areas of atypia (abnormal cell growth).

If a papilloma is found on an excisional biopsy and is removed completely, no further treatment is usually needed.

If a papilloma is found on a needle biopsy:

• Further treatment might not be needed if the papilloma is small, is not causing symptoms, doesn’t contain atypia, and if what was seen on the mammogram looks like a papilloma and not something more serious.
• Removing more tissue in the area might be recommended if it has any concerning features such as atypia.

Talk with your doctor about what is best in your case.

Flat epithelial atypia (FEA)

FEA is an abnormal growth pattern that might show up on a mammogram as an area of calcification (see below). FEA is not cancer, but sometimes it is found near something more serious.

If FEA is found on an excisional biopsy, most often no further action is needed.

If FEA is seen on a needle biopsy, your doctor might recommend that some of the tissue around the biopsy site be removed with surgery. Another option might be to just watch the area with mammograms in the future.

If your biopsy shows FEA, it’s important to talk with your doctor about it because the best way to treat it is not clear.

Fibroepithelial lesions: fibroadenoma or phyllodes tumor

Fibroepithelial lesions are breast tumors that are usually benign. There are 2 main types: fibroadenoma and phyllodes tumor.

If it is unclear which type it is, it might be called a cellular fibroepithelial lesion or a benign fibroepithelial neoplasm. In this case, the tumor is most often treated by removing it completely.

Fibroadenoma

Fibroadenoma is a common benign tumor in the breast. It can often feel like a marble within the breast, or it might show up on a mammogram.

If a fibroadenoma is diagnosed by needle biopsy and there are no further concerning signs on the mammogram, it usually doesn’t need to be removed and can be watched without further treatment.

If the tumor is growing or causing symptoms or problems with the way the breast looks, it might be removed. Another option might be to destroy it with extreme cold, known as cryoablation.

Phyllodes tumor

A phyllodes tumor is a very rare breast tumor that develops from the cells in the stroma (connective tissue) of the breast.

These tumors are usually benign, but they can grow quickly and might come back and make the breast look abnormal if not removed completely.

Rarely, these tumors can be malignant (cancer). Some malignant phyllodes tumors might spread beyond the breast, although this is not common.

If a phyllodes tumor is diagnosed on needle biopsy, it is most often treated by removing it completely with some type of breast-conserving surgery.

Microcalcifications or calcifications

Microcalcifications or calcifications are small calcium deposits that can be found in both noncancerous and cancerous breast lesions. They can be seen both on mammograms and under the microscope.

Because certain calcifications can be found in areas containing cancer, their presence on a mammogram might lead to a biopsy of the area. Once the biopsy is done, the pathologist looks at the removed tissue to be sure that it contains calcifications. If so, the doctor knows that the biopsy sampled the correct area (the abnormal area on the mammogram).

Special lab tests that might be done on biopsy samples

Tests that might be used to help diagnose different types of breast lesions include:

• High molecular weight cytokeratin (HMWCK)
• CK903, also known as 34betaE12
• CK5/6
• p63
• Muscle specific actin
• Smooth muscle myosin heavy chain
• Calponin

Not all biopsy samples need these special tests for an accurate diagnosis. If these tests appear on your pathology report, ask your doctor what the results mean for you.