What are they?
Cysts are fluid filled pockets that form in the tissues of the breast,
causing a mass. Mammography or ultrasound can suggest that a
breast mass is a cyst.
Diagnosis and Treatment
A cyst is diagnosed definitively when a needle is inserted into it
and the doctor is able to draw out fluid. This is ideal for women
with cysts, because the procedure both diagnoses and removes
the cyst at the same time. A cyst should completely disappear
when drained and the tension of it is relieved.
If the fluid removed is not bloody, it does not have to be sent to a
lab for analysis, unless the women is post-menopausal and not on
hormone replacement. The woman needs to come in for a
follow-up in 4-6 weeks. If she is normal at the re-check, then she
may resume routine breast screening. If the cyst reforms, then she
will be sent to a specialist who will check her out for a type of
breast cancer called intracystic carcinoma. A biopsy of the tissue
around the cyst will be done.
If the fluid removed is bloody, it will be sent to a lab for analysis and
the women will be referred to a specialist immediately. Again, this
is to check for the possibility of intracystic carcinoma. A biopsy will
be performed to determine what the breast mass is made of.
If there is a still a breast mass after the removal of all the fluid, that
remaining solid mass should be evaluated like any other solid
breast mass. This means that either the woman will be referred to
a specialist for biopsy or she may be followed with a technique
called 'triple diagnosis". The goal of triple diagnosis is to decrease
the number of unnecessary biopsies. Triple diagnosis is the
combination of Clinical Breast Exam, Mammography, and Fine
Needle Aspiration Biopsy. These are all done in the clinic or office.
If the results of all three tests are negative, then there is about a
99% chance that the mass is harmless. Even so, follow-up at three
and nine months is necessary. If there is any indication of growth of
the mass at the follow-up or if the woman misses parts of the
follow-up of the mass, then a biopsy will be done.
A woman who has had a cyst drained should not have a
mammogram as the aspiration can cause false positive results.
The Bottom Line
When a woman is suspected of having a cyst, it will be drained.
She will be followed up according to her situation and the
character of the fluid. The goal of breast cyst management is to
determine if and when a woman needs a biopsy in the hospital to
check for cancers. However, the cyst in and of itself should not be
the cause of great concern. It is just best to be cautious.