- 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
- Low-level internal echoes:
- Sloping fluid / fluid levels
- Thin wall:
- Ultrasound characteristics:
- 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
- Can positively prove it to be a solid mass lesion:
- Detection of internal vascularity:
- Applying power Doppler:
- As the low internal echos of a complicated cyst:
- 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
- Cytological analysis:
- If the size changes over six months by greater than 20%:
- Short interval follow up:
- Complicated breast cysts:
- Intra-cystic debris:
- Are one of the cystic breast lesions that show:
- 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
Rodrigo Arrangoiz MS, MD, FACS, FSSO 