From the Guidelines
Breast cysts are typically benign and do not require treatment unless they are painful or uncomfortable, in which case fine-needle aspiration may be recommended to drain the fluid and relieve symptoms. According to the National Comprehensive Cancer Network (NCCN) guidelines 1, breast cysts can be categorized into simple, complicated, and complex cysts based on their ultrasonographic characteristics. Simple cysts are considered benign and can be followed with routine screening 1. Complicated cysts, on the other hand, have a low risk of malignancy (<2%) and can be managed with either aspiration or short-term follow-up with physical examination and ultrasonography 1.
Key Considerations
- Breast cysts are common in women between 35-50 years old and are often caused by hormonal fluctuations.
- Most breast cysts do not require treatment unless they are painful or uncomfortable.
- Fine-needle aspiration may be recommended to drain the fluid and relieve symptoms in painful cysts.
- Regular breast self-exams and scheduled mammograms according to age and risk factors are important for ongoing breast health monitoring.
Management Options
- Simple cysts: routine screening 1.
- Complicated cysts: aspiration or short-term follow-up with physical examination and ultrasonography 1.
- Complex cysts: core needle biopsy may be recommended due to the presence of solid components 1.
Important Notes
- Breast cysts should be evaluated by a healthcare provider to rule out other conditions.
- The NCCN guidelines provide a framework for the management of breast cysts, but clinical judgment and individual patient factors should also be taken into account 1.
From the Research
Definition and Classification of Breast Cysts
- Breast cysts are common and can be discovered incidentally or subsequent to pain or palpable mass 2
- They are classified into three categories: simple cysts, complicated cysts, and complex cysts 2
Diagnosis and Management of Breast Cysts
- Fine-needle aspiration (FNA) is a simple, cost-effective, and minimally invasive procedure for diagnosing breast cysts 3
- FNA can be used to aspirate fluid from the cyst, and if clear fluid is aspirated and the mass resolves, malignancy is unlikely 3
- For simple cysts, no further imaging is necessary after ultrasound, and cytology is only considered for analgesic purposes 2
- For complicated cysts, a control at 4-6 months is recommended, and the use of cytology depends on the context (familial risk, difficulty of follow-up) 2
- For complex cysts, sampling by cytology or biopsy is recommended 2
Role of Fine-Needle Aspiration in Breast Cyst Diagnosis
- FNA is a valuable tool for diagnosing breast cysts, with a high negative predictive value (100%) for benign lesions 4
- FNA can also be used to evaluate papillary cystic lesions of the breast, helping to prevent false negative results on concurrent core needle biopsy (CNB) 4
- The combination of FNA and CNB diagnoses is essential for making the correct diagnosis and for clinical management 4
Imaging and Follow-Up of Breast Cysts
- Impalpable complicated breast cysts may be classified as probably benign and can be managed with follow-up imaging studies instead of intervention 5
- Routine cytologic examination is unnecessary if the fluid is not bloody 5
- Follow-up imaging studies can be used to monitor the cyst and ensure that it does not recur or become malignant 3, 5