From the Guidelines
Management of calcified oil cysts in the breast typically involves conservative observation rather than intervention in most cases, as they are benign and pose no risk of malignant transformation, as indicated by the most recent guidelines 1. When a calcified oil cyst is identified on mammography, the first step is to confirm the diagnosis through imaging correlation with ultrasound and review of prior imaging if available.
- Most calcified oil cysts with classic radiologic features (egg-shell or rim calcifications surrounding radiolucent fat) require no treatment, as they are benign and pose no risk of malignant transformation.
- However, if the radiologic appearance is atypical or concerning, a core needle biopsy may be warranted to exclude malignancy, as recommended by the NCCN guidelines 1.
- Symptomatic cysts causing pain or discomfort can be managed with simple aspiration under ultrasound guidance, though recurrence is possible.
- Surgical excision is reserved for cases where malignancy cannot be excluded, when the cyst is significantly symptomatic despite aspiration, or for cosmetic concerns due to large size.
- Patients should be reassured about the benign nature of these lesions and may be followed with routine breast imaging according to age-appropriate screening guidelines, without need for additional surveillance specifically for the oil cyst, as stated in the guidelines 1.
From the Research
Management of Calcified Oil Cyst of the Breast
- The management of calcified oil cyst of the breast is not directly addressed in the provided studies, however, the management of breast cysts in general can be considered.
- Breast cysts can be classified into simple, complicated, and complex cysts based on sonographic findings 2.
- For simple cysts, no further imaging is necessary after ultrasound, and cytology is only considered for analgesic purposes 2.
- Fine needle aspiration (FNA) is a simple, safe, and cost-effective method for diagnosing cystic lesions of the breast 3, 4.
- FNA can be used to diagnose benign cystic lesions, and it also plays a prominent role in evaluating cystic papillary lesions of the breast 3.
- If the aspirate is clear and the mass resolves, malignancy is unlikely, and breast cyst is the probable diagnosis 4.
- Referral for fine-needle or excisional biopsy is indicated if the aspirate is bloody or extremely tenacious, if no fluid can be aspirated, or if there is residual mass after aspiration 4.
- The use of safety technologies, such as safety needles and reciprocating procedure devices, can improve patient and healthcare worker safety during breast cyst aspiration procedures 5.