Complex breast cyst

Dr Rohit Sharma and Radswiki et al.

A complex breast cyst is a morphological type of breast cyst along with simple breast cysts and complicated breast cysts. The current preferred term for complex breast cysts is solid and cystic mass to avoid confusion with a complicated cyst.

Radiographic features

Breast ultrasound

The presence of a thick wall, thick septae, or intracystic mass are characteristic of complex breast cysts 2. The majority show posterior acoustic enhancement due to the cystic component 5. The margin may be macro- or microlobulated, indistinct, or even irregular.

Some authors have defined four categories depending on the appearance 5:

  1. cyst with thick wall >0.5 mm

  2. cysts with thick internal septa (≥0.5 mm)

  3. predominantly cystic complex masses (cystic components at least 50%).

  4. predominantly solid complex masses (at least 50% solid components) including peripheral cystic components

Moving the patient to decubitus position is useful to differentiate the solid masses from thick debris 4.

Treatment and prognosis

Complex breast mass is a wide term and the pathological correlation of this term includes many benign, atypical and malignant lesions 1-6. Some authors find that the complex cystic lesions have 23% up to 31% risk of malignancy 4, while others estimate the risk as 0.3% 4. The former consider the complex breast cyst as intermediate BIRADS IVb lesions, while the latter consider them to be BIRADS IVa lesions 4.

The decision whether any interventional technique should be therefore guided by a clear indication and should be compatible with the patient's history and the result of mammography 4. The radiologist should choose the appropriate measure from the following alternatives:

  • close monitoring

  • sampling

  • fine needle aspiration (FNA)

    • FNA is the first interventional procedure that should be performed when there it is difficult to differentiate between a complicated cyst and a predominantly cystic complex mass
    • purulent fluid suggests an inflammatory lesion and should be assessed by microbiological analysis, while hemorrhagic fluid raises the possibility of malignancy and should analyzed cytologically
    • assessing the lesion after aspiration is important to depict the solid component. if a solid component remains, core biopsy should be performed in the same session 4
  • biopsy

    • core biopsy should be the first intervention if there is a proven solid component associated with a suspicious finding in the mammogram (e.g. micro-calcification or architectural distortion) 4
Breast imaging and pathology
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Article information

rID: 15059
System: Breast
Synonyms or Alternate Spellings:

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