Gao, Yiming

Importance Many patients are diagnosed with benign breast lesions; however, evidence- and consensus-based guidelines for the management of benign breast disease (BBD) are limited. Observations The American Society of Breast Surgeons (ASBrS) and the Society of Breast Imaging (SBI) developed guidelines for the management of benign fibroepithelial lesions (FELs) using a modified Delphi consensus methodology and public comment. There was strong consensus that core biopsy–proven concordant fibroadenomas without atypia only require excision if they were symptomatic, patient preferred, attained a certain size, or demonstrated substantive growth over time on clinical examination. There was strong consensus that when removing a fibroadenoma, complete excision without transection of the mass is recommended and surgeons should consider aesthetics, sensation, and other factors when selecting incision placement. Patients with core biopsy–proven concordant fibroadenomas do not require imaging follow-up and may return to age-appropriate screening. Many benign phyllodes tumors (BPTs) present as an FEL on core biopsy, and these lesions along with any lesions with suspicion of or concern for phyllodes tumors (PTs) require surgical excisional biopsy with complete excision of the mass. Re-excision of a BPT is not required for patients with a positive margin for BPT, but a margin re-excision may be considered if the mass was transected or there is concern of residual disease after excisional biopsy. Patients with BPT who have undergone excision do not require follow-up imaging and may return to age-appropriate screening. Conclusions and Relevance Evidence-informed, consensus and expert opinion-based guidelines for the management of benign FELs of the breast were developed. These guidelines provide clarification on the controversial management of benign FELs of the breast. Any practicing clinicians who treat patients with benign FELs should integrate these guidelines into treatment of their patients.

Abstract Transgender and gender-diverse (TGD) individuals face unique challenges in accessing affirming, evidence-based breast imaging care because of longstanding disparities in provider education, institutional practices, and imaging guidelines. Gender-affirming hormone therapy and gender-affirming surgeries, such as chest masculinization or breast augmentation, impact breast tissue composition and cancer risk, necessitating individualized imaging approaches. Through multiple clinical vignettes, this article illustrates potential pitfalls and key considerations in breast imaging for TGD patients, including appropriate imaging recommendations, inclusive system-level changes, and navigating patient encounters. Education of breast imaging radiologists, technologists, and front-desk staff is critical to bridge the known knowledge gap and improve outcomes for this patient population. By adopting inclusive, culturally competent, and trauma-informed practices, breast imaging professionals can help reduce disparities and improve the experience and health outcomes of TGD patients.