Complicated Breast Cyst

  •  A complicated breast cyst:
    • Are one of the cystic breast lesions that show:
      • Intra-cystic debris:
        • Which may imitate a solid mass appearance
      • They should be carefully differentiated from a complex cyst: 
        • That may require alternative management
      • Radiographic features:
        • Ultrasound characteristics: 
          • Thin wall:
            • With or without posterior acoustic enhancement
          • Homogenous hypoechoic content
            • Low-level internal echoes: 
              • Which may change the shape with the patient position o
          • Sloping fluid / fluid levels
      • The challenge is to differentiate a complicated from a complex cyst:
        • As the low internal echos of a complicated cyst: 
          • May appear as a homogeneous hypoechoic mass
        • If there is hemorrhagic or inflammatory debris which is adherent to the wall:
          • Applying power Doppler: 
            • Detection of internal vascularity:
              • Can positively prove it to be a solid mass lesion:
                • On the other hand, Doppler cannot exclude it 
      • Treatment and prognosis:
        • Complicated breast cysts: 
          • Have less than 2% risk of malignancy and are recommended to be reported as probably benign
        • The management is limited to: 
          • Short interval follow up:
            • If the size changes over six months by greater than 20%: 
              • A diagnostic biopsy is indicated 
            • Aspiration is indicated in a:
              • Symptomatic patient to relieve the symptoms 
              • Newly detected cyst (+/-)
              • Enlarging cysts o In all cases, if aspiration reveals serosanguineous fluid: 
                • Cytological analysis:
                  • Should be performed
  • References:
    • Impact of In-Person and Electronic Training by Breast Radiologists on Rwandan General Practitioners’ and Nurses’ Skills in Diagnostic Breast Ultrasound. K. Shabani et al., JCO Global Oncology, 2018
    • Impact of Training on Rwandan Health Care Staffs’ Skills in Diagnostic Breast Ultrasound. John Butonzi et al., JCO Global Oncology, 2018

@Arrangoiz @CancerSurgeon @BreastSurgeon @SurgicalOncology @CASO @CenterforAdvancedSurgicalOncology #PalmettoGeneralHospital

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