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.
- 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 echos 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
- indicated in a symptomatic patient to relieve the symptoms, newly detected cyst, and enlarged cysts 4
In all cases, if aspiration reveals serosanguineous fluid, cytological analysis should be performed.
- 1.Daly CP, Bailey JE, Klein KA, Helvie MA. Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy?. (2008) Academic radiology. 15 (5): 610-7. doi:10.1016/j.acra.2007.12.018 - Pubmed
- 2.L A Venta, J P Kim, C E Pelloski, M Morrow. Management of complex breast cysts. (2013) AJR. American journal of roentgenology. 173 (5): 1331-6. doi:10.2214/ajr.173.5.10541113 - Pubmed
- 3.Athanasiou A, Aubert E, Vincent Salomon A, Tardivon A. Complex cystic breast masses in ultrasound examination. (2014) Diagnostic and interventional imaging. 95 (2): 169-79. doi:10.1016/j.diii.2013.12.008 - Pubmed
- 4.Devang J. Doshi, David E. March, Giovanna M. Crisi, Bret F. Coughlin. Complex Cystic Breast Masses: Diagnostic Approach and Imaging-Pathologic Correlation. (2007) RadioGraphics. doi:10.1148/rg.27si075508?url_ver=Z39.88-2003