Management of complex breast cysts

OBJECTIVE. This study was undertaken to evaluate the various strategies cur rently in use to manage compiler cysts and specifically address the need fo r intervention. MATERIALS AND METHODS. A review of 4562 breast sonograms obtained during an 18-month period revealed 308 complex cysts in 252 women. Data collected fr om review of patient records included the patient's age and risk factors fo r breast cancer, aspiration or biopsy results (or both), follow-up imaging studies, and management recommendations. RESULTS. Management recommendations for complex cysts were 1-year follow-up in 13 patients, 6-month follow-up in 148, sonographically guided aspiratio n in 82, aspiration with possible core biopsy in 62, and excisional biopsy in three. No malignancies were diagnosed in the group treated with follow-u p imaging, sonographically guided aspiration, or excisional biopsy. One mal ignancy, a papilloma with a 3-mm focus of ductal carcinoma in situ, was dia gnosed in one of the patients who underwent core biopsy. CONCLUSION. Of the lesions classified as complex cysts, the malignancy rate was 0.3% (1/308). This malignancy rate is lower than that for lesions clas sified as probably benign using mammographic criteria (i.e., for lesions cl assified as category 3 lesions using the Breast Imaging Reporting and Data System). Because the accepted standard practice for management of probably benign lesions is follow-up studies, the low yield of malignancy in this se ries suggests that complex cysts can be managed with follow-up imaging stud ies instead of intervention.