Imaging Approach and Management of Breast Cysts

In ultrasonography, breast cysts are categorized into simple, complicated, and complex types. A Breast complicated cyst can be defined as any cyst that does not meet the strict criteria for a simple cyst and is less likely to be malignant than in any other organ. Complex breast cysts are common, and owing to the use of higher-resolution equipment, are increasingly detected. Complex breast cysts are defined as cysts with thick walls, thick septa and intracystic masses or other discrete solid components. Many patients have numerous different cysts in each breast. Such lesions are too numerous to be biopsied, aspirated, or even followed. In order to both avoid mischaracterizing malignant complex cysts as benign and minimize the number of biopsies on the far more numerous suspicious-appearing benign complicated cysts, the sonographer must develop a systematic approach for evaluating the risk associated with individual breast cysts. Each breast cyst must be characterized into a Breast Imaging Reporting and Data System (BIRADS) category. We first describe cyst related breast anatomy and then an algorithm for breast cysts approach.