Breast cysts Flashcards
What is a breast cyst?
A fluid-filled lump in the breast.
Define fibrocystic disease.
Non-specific term for the continuum or physiological changes that expand to the pathological spectrum.
It includes lumpy breasts associated with pain and tenderness that fluctuate with the menstrual cycle.
What are the risk factors for fibrocystic breasts?
- Age 30-50yrs
- HRT (oestrogen especially)
- Obesity
- Nulliparity
- Later age at first childbirth
- Within two weeks prior to period
What are the signs and symptoms of a breast cyst?
- Surface - smooth
- Borders - distinct
- Consistency - firm to lax
- Mobility - no
- Fixity (tethering to skin/underlying muscle) - no
- Lymphadenopathy - no
Rapid onset - may appear overnight and undergo rapid increase in size
May undergo cyclical changes (e.g. becoming more tender) - usually more with “benign cystic change”. But 30% unaffected by menstrual cycle.
May or may not be tender - fibrocystic disease tender in areas of ruptured cysts
How are all solid lumps investigated in a breast clinic?
Triple assessment
- Clinical examination
- Radiological examination - US if <35yrs; 2-view mammogram if >35yrs
- Fine needle aspiration/core biopsy - tells about types of cells (dysplastic?) and biopsy about architecture of surrounding structures.
What does US show in breast cysts? How do you confirm diagnosis?
Non mobile, not fixated or tethered to overlying skin mass, which is well-defined and hypoechoic
Diagnosis is confirmed by aspirating the cyst 0 this will show green (or even black, brown, yellow) fluid. The breast should be re-examined once the cyst has been aspirated to dryness.
What are the complications of a breast cyst?
If re-examination after aspiration is not normal it may require triple assessment again as a carcinoma can develop within cysts.
What are the scoring systems for a breast lump? What does P4R4C4B5 mean?
Two components of the scoring system. Letters refer to the triple assessment:
- P - physical examination
- R - radiological examination
- C - cytology/FNA
- B - biopsy core
Each aspect is given a score out of 5:
- 1 - normal or inadequate sample
- 2 - benign
- 3- probably benign
- 4 - probably malignant
- 5 - malignant
Sensitivity of triple assessment in UK is >99.5%.
What does the term benign cystic change encompass?
- Fibrocystic change
- Fibroadenosis
- Benign breast change
How common are breast cysts?
Affect approximately 50% of women during their reproductive years
What are the main features of fibrocystic disease vs breast cyst?
Fibrocystic disease is diffuse and symmetrical
Mastalgia in fibrocystic disease usually in areas of ruptured cysts
What are the differences between suspicious and non-suspicious nipple discharge?
Non-suspicious - scant, milky, green, grey, black, uni/bilateral, several ducts expressing
Suspicious - watery, bloody, profuse, emanates from single duct
What are the most common causes of non-puerperal nipple discharge?
Intraductal papilloma (70%)
Ductal ectasia (25%)
Breast cancer (5%)
Should diffuse symmetrical breast lumpiness be diagnosed as fibrocystic disease?
No - this is common and not always pathological
Pain alone is also not an indication for imaging and investigation
What characteristic features of breast cyst are shown on this USS?
Smooth and sharp margins
Anechoic lesion with posterior acoustic enhancement
