From the Guidelines
Breast cysts that are classified as simple can be managed with therapeutic fluid aspiration if clinical symptoms persist, and these patients can be followed up with routine screening. The management of breast cysts depends on their classification, with simple cysts being considered benign if clinical findings and ultrasonographic results are concordant 1. For complicated cysts, options include aspiration or short-term follow-up with physical examination and ultrasonography with or without mammography every 6 to 12 months for 1 to 2 years to assess stability 1.
Some key points to consider in the management of breast cysts include:
- The risk of malignancy associated with a complicated non-simple cyst is very low (< 2%) 1
- Cytologic examination is recommended if bloody fluid is obtained 1
- Complicated cysts that increase in size or suspicion should be biopsied 1
- Those that are stable or confirmed to be a complicated cyst with visible mobility of internal components can be followed up with routine screening 1
Aspiration may be more strongly considered in a patient likely to be lost to follow-up. It's also important to consider the patient's symptoms, risk of complications, and preference when making treatment decisions. Regular monitoring is crucial to ensure that the cyst does not grow or cause problems. Overall, the management of breast cysts should be individualized based on the specific characteristics of the cyst and the patient's overall health.
From the Research
Treatment Guidelines for Cysts
- The management of cysts depends on their location, size, and symptoms, as well as the presence of any complications such as infection or bleeding 2, 3, 4.
- For simple cysts, aspiration and sclerotherapy with alcohol and erythromycin can be effective in relieving symptoms and preventing recurrence, especially for ovarian cysts 3.
- However, the recurrence rate can be high, especially if the aspirate is bloody, and patients with a high risk of malignancy may require surgical intervention 3, 4.
- For renal cysts, percutaneous sclerotherapy with alcohol or aethoxysclerol followed by extended drainage can be an effective treatment option, with a success rate of 97.2% in one study 5.
- The choice of sclerosing agent depends on the size of the cyst, with alcohol being more effective for larger cysts but having more negative side effects, and aethoxysclerol being less expensive and having fewer side effects but potentially leading to septic complications 5.
- Ultrasound and color Doppler ultrasound can be used to characterize and manage renal cystic lesions, and a feature-oriented algorithmic approach can be used to classify these lesions and guide treatment decisions 6.
Specific Treatment Options
- Percutaneous drainage and sclerotherapy can be used to treat symptomatic simple renal cysts, with a success rate of 95.3% in one study 5.
- Sclerotherapy with alcohol and erythromycin can be used to treat simple ovarian cysts, with a relatively high recurrence rate but potential benefits for patients with symptomatic cysts who are at low risk for malignancy 3.
- Aspiration and biopsy can be used to diagnose and treat complex cysts or those with suspicious cytological results, with the goal of ruling out malignancy and guiding further treatment decisions 4.