Complicated breast cyst

Last revised by Owen Kang on 30 Dec 2022

Complicated breast cysts are one of the cystic breast lesions that show intracystic debris which may imitate a solid mass appearance. They should be carefully differentiated from a complex cyst and may require alternative management 3.

Radiographic features

  • thin wall with or without posterior acoustic enhancement 3

  • homogenous hypoechoic content 3

  • low-level internal echoes which may change the shape with the patient position 4

  • sloping fluid-fluid levels 4

The challenge is to differentiate a complicated from a complex cyst as the low internal echoes of a complicated cyst may appear as a homogeneous hypoechoic mass 4.

If there is hemorrhagic or inflammatory debris which is adherent to the wall, applying power Doppler and detection of internal vascularity can positively prove it to be a solid mass lesion. On the other hand, Doppler cannot exclude it 4.

Treatment and prognosis

Complicated breast cysts have less than 2% risk of malignancy and are recommended to be reported as probably benign 2. Thus, the management is limited to 1:

  • short interval follow up

    • if the size changes over 6 months by >20%, a diagnostic biopsy is indicated 4

  • aspiration

    • indicated in a symptomatic patient to relieve the symptoms, newly detected cyst, and enlarged cysts 4

In all cases, if aspiration reveals serosanguineous fluid, then cytological analysis should be performed.

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