The diagnosis and pathological evaluation of impalpable breast lesions require a multidisciplinary approach combining radiological imaging, precise surgical techniques, and detailed pathological assessment. Impalpable lesions often represent early-stage breast cancers or high-risk abnormalities, which are being increasingly detected through the breast screening programme as well as through incidental imaging findings. This chapter explores the pathology-specific aspects of managing those lesions, emphasising the role of radiological–pathological correlation and histological examination. Key topics include the pathology approach of excised lesions under wire-guided and wire-free localisation methods, the application of specimen X-ray imaging for lesion mapping, and the macroscopic and microscopic assessment of different breast specimen types including axillary specimens. Special attention is given to the challenges posed by ductal carcinoma in situ as the most common malignant impalpable breast lesion, the assessment of neoadjuvant cases, and the incidental findings in oncoplastic specimens.