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Malignant Lump, Benign Cytology, Recurrent Cysts

Introduction

Fibroadenoma
Fibroadenosis
Breast Cyst
Breast Abscess
Breast Cancer
Conclusion

Breast Cyst - Is Aspiration Adequate?

Breast cyst is a common cause of breast lump in woman in their late thirties and forties. Most authorities now accept that cysts are formed as a result of breast involution. This process, which starts in a woman past her reproductive period, leads to degeneration of her fibroglandular tissue. This results in the formation of spaces which form cysts when filled with fluid.

Cysts are usually multiple and bilateral and can vary from small (<1cm diameter and non palpable) to big (>2cm diameter). They feel firm and their margins are not as well defined as that of a fibroadenoma. Hence, it may be difficult to differentiate it from a malignant lump clinically. Ultrasound scan is most helpful as it can readily distinguish between a cyst and a solid lump.

The treatment of choice remains needle aspiration using a 23 gauge needle. For non-palpable cysts, an ultrasound scan is used to guide the needle aspiration. The aspirate can then be analysed for malignant cells.

In summary, if the following criteria are satisfied after needle aspiration one can observe the patient:

1)  Non bloody aspirate

2)  No residual lump

3)  Benign cytology

If the above criteria is not satisfied, the cyst should be excised to exclude a cancer.

Recurrent cysts are a major problem as 20% of cysts recur after aspiration. Most can be managed by repeated aspiration. However, excision should be considered for cysts that recur more than 3 to 4 times.

 

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