What are the key components of a good Point-of-Care Ultrasound (POCUS) Butterfly Ultrasound (US) note for a 1cm cystic breast mass located subareolarly?

POCUS Breast Ultrasound Documentation for 1cm Subareolar Cystic Mass

For a 1cm cystic breast mass located in the subareolar region, the ultrasound report should document the lesion as a simple cyst if it meets all benign criteria, requiring no further workup beyond routine screening. 1

Key Components of Documentation

Patient Demographics and Clinical Information

• Patient identifier and age
• Relevant clinical history (prior breast issues, family history)
• Indication for examination (palpable subareolar mass)
• Breast laterality (right vs left)

Technical Parameters

• Ultrasound device used (Butterfly handheld device)
• Transducer frequency utilized
• Patient position during examination
• Scanning technique (radial/anti-radial or orthogonal planes)

Mass Characteristics

• Location: Subareolar region with clock face position and distance from nipple
• Size: 1cm in three dimensions (length × width × height)
• Shape: Round/oval/irregular
• Margins: Circumscribed/microlobulated/indistinct/angular/spiculated
• Echo pattern: Anechoic (for simple cyst)
• Posterior features: Posterior acoustic enhancement (typical for cysts)
• Wall characteristics: Thin and imperceptible wall (for simple cyst)

Assessment and Classification

• BI-RADS classification: BI-RADS 2 (benign) for simple cyst 2
• Correlation with physical examination findings
• Comparison with prior imaging (if available)

Specific Documentation for Cystic Lesions

Simple Cyst Documentation

If the mass demonstrates all features of a simple cyst:

• Anechoic content
• Well-circumscribed margins
• Thin imperceptible walls
• Posterior acoustic enhancement
• No internal echoes or solid components 3

Complicated Cyst Documentation

If the mass shows features of a complicated cyst:

• Low-level internal echoes
• Fluid-debris level
• Thin septations (<0.5mm)
• No solid component 3, 4

Complex Cyst Documentation

If the mass shows features of a complex cyst:

• Thick walls (≥0.5mm)
• Thick septations (≥0.5mm)
• Intracystic mass or mural nodule
• Mixed cystic and solid components 5, 3

Management Recommendations Based on Findings

For Simple Cyst

• No further workup needed 1
• Document: "Simple cyst with benign characteristics, no further imaging evaluation needed. Return to routine screening."

For Complicated Cyst

• Short-term follow-up in 4-6 months 4
• Document: "Complicated cyst with low-level internal echoes. Recommend follow-up ultrasound in 4-6 months to ensure stability."

For Complex Cyst

• Tissue sampling recommended (core biopsy preferred over FNA) 1, 5
• Document: "Complex cystic mass with [specific concerning features]. Recommend ultrasound-guided core biopsy for definitive diagnosis."

Common Pitfalls to Avoid

1. Failing to document all three dimensions of the mass
2. Omitting correlation with physical examination findings
3. Not specifying exact location using clock face position
4. Inadequate characterization of wall thickness and internal components
5. Missing additional lesions in the surrounding tissue
6. Failing to assess regional lymph nodes
7. Not providing clear management recommendations based on findings

Remember that while most cystic breast masses are benign, complex cystic masses with thick walls, thick septations, or mural nodules have a higher risk of malignancy (approximately 23% in one series) and require tissue sampling for definitive diagnosis 3.