Breast cysts (SURG)

Question 1

What is a breast cyst?

Answer 1

A benign, well-defined collection of fluid within the breast that is influenced by hormonal changes

Question 2

How common are breast cysts?

Answer 2

Very common - 25% of all breast masses

Most common in perimenopausal women, with peak incidence 35-50y

Question 3

Who are breast cysts most common in?

Answer 3

Perimenopausal women with peak incidence 35-50y

Question 4

What are fibrocystic changes (breast cyst)?

Answer 4

• non-cancerous (benign) changes in fibrous tissue (fibrosis) and/or cysts are known as fibrocystic changes
• fibrocystic breast changes can happen in different parts of the breast and both breasts at the same time

Question 5

How does a breast cyst usually present? (3)

Answer 5

• small discrete breast lump (soft fluctuable swelling):
  
  • single or multiple breast masses
  • may be painful/tender
  • variable size + texture
  • mobile (easily moveable)
• breast pain and tenderness
• increased lump size and tenderness just before menstruation

Question 6

Describe the breast lump if a patient has a breast cyst.

Answer 6

• single or multiple breast masses
• may be painful/tender
• variable size + texture
• mobile (easily moveable)

Question 7

How are fibrocysts (breast cysts) described?

Answer 7

Known to fluctuate with menstrual cycle and present as ‘lumpy’ breasts in more than one place, and may be on both breasts

Question 8

How do we investigate a breast lump (breast cyst)?

Answer 8

Triple assessment:

1. clinical examination
2. radiology - ultrasound for <35y, mammography AND ultrasound for <35y
3. histology/cytology (FNA or core biopsy: US-guided core biopsy is best for NEW lumps)

Question 9

What would we see on mammography in breast cyst?

Answer 9

Halo appearance, well-circumscribed with sharp borders

Question 10

What does ultrasound confirm in breast cyst?

Answer 10

Fluid-filled nature of cyst

Mammography cannot distinguish between cysts and solid masses, US needed

Question 11

How do we interpret ultrasound findings in a breast lump?

Answer 11

• cystic lump (breast cyst): aspirate –> residual mass = core biopsy, clear fluid = discard fluid and reassure, bloody fluid = cytology
• solid lump: core biopsy –> malignant = plan Rx, clear fluid = discard fluid and reassure

Question 12

What does the fluid in a breast cyst often look like?

Answer 12

Straw-coloured bloody fluid

Question 13

What are some differential diagnoses for breast cysts? (5)

Answer 13

• apocrine metaplasia
• fibrosis
• cyst formation
• proliferative changes
• atypical duct hyperplasia

Question 14

What supportive measures can we suggest for breast cyst? (4)

Answer 14

• supportive bra
• analgesia
• evening primrose oil
• HRT if breast pain (tamoxifen, bromocriptine or danazol)

Question 15

How do we usually manage a breast cyst?

Answer 15

Aspiration

Question 16

How do we manage blood-stained or persistently refilling breast cysts?

Answer 16

Biopsy or excision

Question 17

What do we do if a breast cyst is large, painful and has signs of infection?

Answer 17

Ultrasound-guided fine needle aspirate (US-guided FNA)

Question 18

What do we do with complex breast cysts that may develop into breast cancer?

Answer 18

Ultrasound-guided core needle biopsy

Question 19

What presentations do we refer on the 2WW for breast cancer (breast cyst)?

Answer 19

• age 30+ with unexplained breast lump +/- pain
• age 50+ with discharge, retraction or other concerning changes in one nipple only

Question 20

When do we refer for routine non-urgent breast clinic?

Answer 20

Age <30 with unexplained breast lump +/- pain

Question 21

What do we do if a patient presents with nipple discharge?

Answer 21

• non-suspicious/no mass = reassurance with observation
• breast mass present = referral to oncologist –> surgery

Question 22

What is a complication of breast cysts?

Answer 22

Breast cancer