Medical Central Resource
Simple breast cyst
Brent Stephenson
5/20/97
Presentation
70 year old female whose mother and two sisters diagnosed with breast cancer in 50's and 40's respectively. No complaints.
Imaging Technique
Plain X-ray
Ultrasound
Imaging Findings
Standard mammographic views revealed a 2.5 cm well-circumscribed mass at the 3 O'clock position of the left breast. Ultrasound demonstrated a anechoic, 2.1 cm lesion with posterior acoustical enhancement which corresponded with the mammographic abnormality.
On a follow up visit the cyst was aspirated under ultrasound guidance. Approximately 2.3 cc of greenish fluid were withdrawn and1.2 cc room air injected. Post-procedure CC and MLO views revealed an air-filled cystic structure with very smooth interior lining.
Diagnosis
Simple breast cyst
Discussion
As a general rule, cyst aspiration is performed for symptomatic cases or in situations where ultrasound raises the question of a mural nodule. The procedure involves aspiration of cyst fluid followed by replacement with 50-75% of that volume with air. Over distension may result in rupture of the membrane and air within the breast parenchyma. CC and Lateral views are obtained to evaluate the air-filled cyst cavity for mural irregularities. Studies suggest that cytologic yield for malignancy is low for green or yellowish fluid and that only bloody aspirates should be routinely submitted for cytologic testing.
For uncomplicated cysts (i.e. circumscribed anechoic mass with posterior acoustic enhancement and a well-defined back wall) postaspiration mammography is not essential.
Breast cancer is found in fewer than 1% of cyst biopsy specimens, however, reaccumulation of fluid in a cyst that has been drained more than three times is suspicious for an associated neoplasm. Surgical removal is warranted. Thickening or irregularity of a cyst wall on mammography or sonography are suspicious findings for neoplasia.
Submitted by: Brent Stephenson,Capt,USAF,MC,Wilford Hall Medical Center
Reviewed by: Thomas Ruhnke,Maj,USAF,MC,Wilford Hall Medical Center
References
Set 36: Breast Disease (Second Series) Test and Syllabus. The American College of Radiology. 1993.
