Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF): benign breast tumors–Short Text

Vincent Lavoué (1, 2) , Xavier Fritel (3, 4) , Martine Antoine (5) , Françoise Beltjens (6) , Sofiane Bendifallah (7) , Martine Boisserie-Lacroix (8) , Loïc Boulanger (9) , Geoffroy Canlorbe (7) , Sophie Catteau-Jonard (9) , Nathalie Chabbert-Buffet (7) , Foucauld Chamming'S (10) , Elisabeth Chéreau (11) , Jocelyne Chopier (12) , Charles Coutant (6) , Julie Demetz (9) , Nicolas Guilhen (13) , Raffaèle Fauvet (14) , Olivier Kerdraon (15) , Enora Laas (7) , Guillaume Legendre (4, 16) , Carole Mathelin (17) , Cédric Nadeau (18) , Isabelle Thomassin Naggara (12) , Charlotte Ngô (19) , Lobna Ouldamer (20, 21, 22) , Arash Rafii (23, 24, 25) , Marie-Noelle Roedlich (26) , Jérémy Seror (26, 12) , Jean-Yves Séror (27) , Cyril Touboul (28) , Catherine Uzan (29) , Emile Darai (7)

1 Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes]
2 OSS - Oncogenesis Stress Signaling
3 CIC - Poitiers
4 CESP - Centre de recherche en épidémiologie et santé des populations
5 Service d'Anatomie et cytologie pathologiques [CHU Tenon]
6 UNICANCER/CRLCC-CGFL - Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon]
7 Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon]
8 Centre Régional de Lutte Contre le Cancer Bergognié
9 Hôpital Jeanne de Flandre [Lille]
10 Service de radiologie cardio-vasculaire [CHU HEGP]
11 Institut Paoli-Calmettes
12 CHU Tenon [AP-HP]
13 CHU Poitiers - Centre hospitalier universitaire de Poitiers
14 UMRS893 - Centre de Recherche Saint-Antoine
15 Centre de Biologie Pathologie
16 CHU Angers - Centre Hospitalier Universitaire d'Angers
17 IGBMC - Institut de génétique et biologie moléculaire et cellulaire
18 Department of Gynecology and Obstetrics
19 Chirurgie cancérologique gynécologique et mammaire
20 N2C - Nutrition, croissance et cancer (U 1069)
21 Hôpital Bretonneau
22 Faculté de Médecine
23 Stem cell and microenvironment laboratory
24 Department Genetic Medicine
25 UMR 1203 - Développement embryonnaire précoce humain et pluripotence EmbryoPluripotency
26 Medical Practice
27 Imagerie Duroc
28 Service de Gynécologie-Obstétrique
29 CHU Pitié-Salpêtrière [AP-HP]

Screening with breast ultrasound in combination with mammography is needed to investigate a clinical breast mass (Grade B), colored single-pore breast nipple discharge (Grade C), or mastitis (Grade C). The BI-RADS system is recommended for describing and classifying abnormal breast imaging findings. For a breast abscess, a percutaneous biopsy is recommended in the case of a mass or persistent symptoms (Grade C). For mastalgia, when breast imaging is normal, no MRI or breast biopsy is recommended (Grade C). Percutaneous biopsy is recommended for a BI-RADS category 4-5 mass (Grade B). For persistent erythematous nipple or atypical eczema lesions, a nipple biopsy is recommended (Grade C). For distortion and asymmetry, a vacuum core-needle biopsy is recommended due to the risk of underestimation by simple core-needle biopsy (Grade C). For BI-RADS category 4-5 microcalcifications without any ultrasound signal, a minimum 11-G vacuum core-needle biopsy is recommended (Grade B). In the absence of microcalcifications on radiography cores additional samples are recommended (Grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial atypia, radial scar and mucocele with atypia, surgical excision is commonly recommended (Grade C). Expectant management is feasible after multidisciplinary consensus. For these lesions, when excision margins are not clear, no new excision is recommended except for LCIS characterized as pleomorphic or with necrosis (Grade C). For grade 1 phyllodes tumor, surgical resection with clear margins is recommended. For grade 2 phyllodes tumor, 10 mm margins are recommended (Grade C). For papillary breast lesions without atypia, complete disappearance of the radiological signal is recommended (Grade C). For papillary breast lesions with atypia, complete surgical excision is recommended (Grade C)

Keywords: Mammogram; Benign breast tumor; BI-RADS classification; Ultrasound; Pathological examination

Domains: Life Sciences [q-bio]; Human health and pathology; Gynecology and obstetrics

Vincent Lavoué, Xavier Fritel, Martine Antoine, Françoise Beltjens, Sofiane Bendifallah, et al.. Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF): benign breast tumors–Short Text. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016, 200, pp.16-23. ⟨10.1016/j.ejogrb.2016.02.017⟩. ⟨hal-01282343⟩