Breast cysts

Question 1

What is a breast cyst?

Answer 1

a well-defined collection of fluid within glandular tissue influenced by hormonal change
- most are benign
- Exact cause unknown

Question 2

What are the risk factors for breast cysts?

Answer 2

• Usually disappear after menopause – related to hormone changes (overproduction of estrogen, suppression of progesterone)
• Older postmenopausal patients who are on hormone replacement therapy are at an increased risk

Question 3

Describe the epidemiology of breast cysts

Answer 3

Common in >35 yrs esp perimenopausal

Question 4

What are the presenting symptoms of breasts cysts?

Answer 4

● Small breast lump – smooth, distinct border, firm to lax consistency (depending on fluid pressure within), immobile, not fixed
- single or multiple breast masses
● Causes breast pain (worsens prior to menstruation)
● Tenderness
● Increased lump size and tenderness just before menstruation
- some pts are asymptomatic

Question 5

What are some signs of breast cysts found on examination?

Answer 5

• Fluid-filled
• rounded lump; not fixed to surroundings; easily movable; smooth
• can be tender

Question 6

What are the 3 different ways of classifying a breast cyst?

Answer 6

• simple
• complicated
• complex

Question 7

What investigations are used to monitor possible breast cysts?

Answer 7

● Triple assessment:
Breast Ultrasound or Mammography → depending on womans age (Ultrasound in younger patients, <30/35) :
- ‘Halo Appearance’ on mammography
- Ultrasound will confirm the fluid filled nature of the cyst

Question 8

How should a breast cyst be managed?

Answer 8

1. Aspiration ⇒ those which are blood stained or persistently refill should be biopsied or excised
2. If cyst is large, painful and has signs of infection → ultrasound-guided FNA (fine needle aspiration)
3. Complex cysts may develop into breast cancer → ultrasound-guided core needle biopsy