Cystic Breast Masses Research Articles

Diagnostic Accuracy of Fine Needle Aspiration Cytology, Triple Test and Tru-cut Biopsy in the Detection of Breast Lesion

Background: The majority of breast illnesses manifest as a palpable mass. The vast majority of breast lesions are not malignant, and the vast majority of benign lesions do not progress to cancer; however, the accuracy of diagnosis can be improved by a combination of preoperative tests such as physical examination, mammography, fine-needle aspiration cytology (FNAC), and Trucut needle biopsy (TCNB) or core needle biopsy (CNB). FNAC has gained in popularity and is now the primary treatment performed after a history and clinical examination to diagnose solid and cystic breast masses. This study was designed to assess the accuracy of FNAC in comparison to Triple Test and TCNB for the diagnosis of breast masses. Methodology: From January 2023 through May 2023, this study was conducted in the Tezpur Medical College and Hospital. The research included all female patients over the age of 20 with clinically palpable lumps. Palpable breast lumps need a complete clinical breast examination, imaging, and tissue sample for a clear diagnosis to rule out cancer.The Ultrasonography/Mammography, FNAC and tru-cut biopsy procedures were performed concurrently in the same region, and the results were compared to final histopathology as the gold standard. Result: The majority of the patients in the study were in age group of > 60 years. In our study Left breast was involved in 41 (58.5%) patients and right breast in 29 (41.4%) patients. The most frequent site involved was upper outer quadrant in 38 (54.2%). The overall sensitivity of FNAC in our study was 93.75%, tru-cut biopsy is 100% and that of triple test is 100% and specificity for malignancy was 91.6%, 93.6 and 95.6% for FNAC, tru-cut biopsy and triple test respectively. Conclusion: All three techniques have advantages and disadvantages. Core Needle Biopsy cannot be used in place of FNAC, and it is not required to identify all breast lesions. It can be utilised as an adjuvant in circumstances when cytology is definitive and biomarker tests are required. triple test and trucut were more accurate than FNAC in our testing.Trucut biopsy was able to provide histological diagnosis, and the findings were 100% consistent with the final histopathology report.

Coherence Metrics for Reader-Independent Differentiation of Cystic From Solid Breast Masses in Ultrasound Images.

Traditional breast ultrasound imaging is a low-cost, real-time and portable method to assist with breast cancer screening and diagnosis, with particular benefits for patients with dense breast tissue. We previously demonstrated that incorporating coherence-based beamforming additionally improves the distinction of fluid-filled from solid breast masses, based on qualitative image interpretation by board-certified radiologists. However, variable sensitivity (range: 0.71-1.00 when detecting fluid-filled masses) was achieved by the individual radiologist readers. Therefore, we propose two objective coherence metrics, lag-one coherence (LOC) and coherence length (CL), to quantitatively determine the content of breast masses without requiring reader assessment. Data acquired from 31 breast masses were analyzed. Ideal separation (i.e., 1.00 sensitivity and specificity) was achieved between fluid-filled and solid breast masses based on the mean or median LOC value within each mass. When separated based on mean and median CL values, the sensitivity/specificity decreased to 1.00/0.95 and 0.92/0.89, respectively. The greatest sensitivity and specificity were achieved in dense, rather than non-dense, breast tissue. These results support the introduction of an objective, reader-independent method for automated diagnoses of cystic breast masses.

Complex Cystic Breast Masses: An Ultrasound Imaging Review

Cystic lesions are very commonly encountered entities in the breast. Among these, Complex Cystic Breast Masses (CCBMs), which contain both anechoic and echogenic components, can result in a variety of imaging appearances. These include cystic lesions with thick walls and/or internal septa, intracystic nodular lesions, and solid-cystic masses of varying compositions. Ultrasound is the mainstay for evaluating cystic lesions, and thus recognizing the imaging features appropriately and suggesting suitable interventional procedures are included in their management. In this pictorial essay, we describe the wide range of ultrasound appearances of CCBMs with a number of clinically encountered examples from our institution. This article would enhance the understanding of readers in possible differentials to be included in their clinical practice and to suggest appropriate further intervention, when deemed necessary.

Juvenile papillomatosis of the breast (Swiss cheese disease) has frequent associations with PIK3CA and/or AKT1 mutations

Juvenile papillomatosis (JP), the so-called Swiss cheese disease, is a rare benign breast disease of young adults. An association (up to 28%) with breast cancer within the family of affected patients has been reported. A multinodular cystic breast mass lesion and calcifications characterizes JP in imaging studies. The histological picture is diverse and comprises multiple intraductal papillomas, usual ductal hyperplasia, ductectasias, perifocal sclerosing adenosis, and calcification. Patients with complete excision of JP lesions have an excellent follow-up; breast cancer develops only on a very low subset of patients. Molecular background of JP has not been investigated until now. In this study, we addressed mutational analysis of JP cases and correlated these results with follow-up and family history in context with a comprehensive review of the JP literature. We identified 13 cases fulfilling the criteria of JP. All patients were women with a median age of 38 years (26-50 years). Follow-up information was available for 11 of 13 patients. Sufficient paraffin-embedded tissue and good DNA quality for next-generation sequencing (NGS) was available for 10 patients. Paraffin blocks were microdissected in the area of intraductal proliferative disease; the tissue cores underwent NGS analysis using the Oncomine Comprehensive Panel. In 5 of 10 patients, we found PIK3CA mutations; in 2 of 10 patients, we found AKT1 mutations in known hot spot regions. Further mutations in MET, FGFR3, PTEN, ATM, NF1, and GNAS genes were detected in individual patients. Some of these mutations were present at high allele frequencies suggesting germ line mutations. Two of 3 patients with positive family history had PIK3CA mutation; one patient with positive family history had an AKT1 mutation. One patient who subsequently developed invasive ductal carcinoma in the contralateral breast possibly had a germ line ATM mutation. Our results confirm hot spot mutations in PIK3CA and AKT1 genes in JP associated with positive family history for breast cancer, although these mutations are not specific for JP. The genetic link between JP, positive family history, and subsequent risk of breast cancerneeds to be analyzed in further studies.

The value of ultrasound classification in BI-RADS category 4 of breast complex cystic masses

Objective: To analyze the feature of breast complex cystic masses and to classify it at ultrasonography (US), which applied to the Breast Imaging Reporting and Data System (BI-RADS) categories 4a to 4c with pathological results as the golden standards. Methods: The ultrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features: type 1 [thick wall and (or) thick septa (> 0.5 mm)], type 2 (one or more intra-cystic masses), type 3 (mixed cystic and solid components with cystic components more than 50%) and type 4 (mixed cystic and solid components with solid components more than 50%). Positive values (PPVs) were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses (lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc.) with malignant correlation. Results: There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 (17.3%) were classified as type Ⅰ, 18 (22.2%) as type Ⅱ, 18 (22.2%) as type Ⅲ, and 31 (38.3%) as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ, type Ⅱ, Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively (P=0.040). In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI≥0.7 and presence of abnormal axillary nodes assessment had a high probability of malignancy (P=0.030, 0.038, <0.001 and 0.025, respectively). Conclusion: Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.

Cysts with masses and masses with cysts: An imaging review of cystic breast masses

Cysts with masses and masses with cysts: An imaging review of cystic breast masses

Papiller Kanser ile Karişan Papiller Apokrin Metaplazi Vakası

Cystic breast lesions which are detected by ultrasonography are classified as simple, complicated or complex. Complex cystic breast masses can be benign, atypical, or malignant lesions. Cysts with thick walls, thick septa, intracystic masses, or other discrete solid components are defined as complex cysts. The case was here presented of a 47-year old female with a complex cystic breast lesion, the sonographic, mammographic and histpathological findings of which resembled malignancy. Imaging studies allow the determination of tumour character, but mammographic or sonographic methods are insufficient to differentiate these lesions from one another. Biopsy and imaging-pathology correlation are necessary for a definitive diagnosis.

Complex cystic breast masses in ultrasound examination

Complex cystic masses are defined as lesions composed of anechoic (cystic) and echogenic (solid) components, unlike complicated cysts, the echogenic fluid content of which imitates a solid lesion. Complex masses are classified as ACR4 and require histological verification by percutaneous biopsy and/or surgical ablation. The etiology is diverse, and can be benign or high risk (an abscess, hematoma, fat necrosis, fibrocystic mastopathy, a phyllodes tumor, papilloma) as much as malignant (papillary cancer, necrotic cancer, a ductal carcinoma in situ, metastases). The biopsy technique must be adapted to each case and it is often necessary to insert a coil during the procedure. Histopathological correlation is essential to ensure that the samples are representative and concur with the ultrasound appearance, so as not to fail to recognize high risk or malignant lesions requiring appropriate management.

Sonographic-pathologic correlation of complex cystic breast lesions

ObjectiveTo understand the pathologic basis for sonographic features of complex cystic lesions. MethodsFrom 2646 female patients underwent breast sonography at King Chulalongkorn Memorial Hospital from January 2005 through December 2010, 103 cystic lesions were included. Pathologic confirmation was performed by fine-needle aspiration (n=42), core needle biopsy (n=6), excision (n=54) and mastectomy (n=1). Complex cystic breast masses were classified into 3 types as followings; thick outer wall and/or thick internal septa (type I); thick septation and thick wall were defined as equal or more than 0.5 cm, masses containing mixed cystic and solid components (at least 50% of cystic component) (type II), predominantly solid with eccentric cystic foci (at least 50% of solid component) (type III). ResultsIn 103 complex cystic masses, there are 27 lesions (26%) classified as type I cystic breast masses, 37 lesions (36%) as type II cystic breast masses and 39 lesions (38%) type III cystic breast masses, 26 lesions (25.2%) are proved to be malignant. All of type I cystic breast masses in our study are benign, and 14 (38%) of type II cystic breast masses and 12 lesions (31%) of type III cystic breast lesions are proved to be malignant. ConclusionsType II and III lesions should suggest possibility of malignancy and biopsy should be performed in all lesions. All type I lesion in this study are benign. None of other parameters we included in this study (size or margin) can effectively differentiate between benign or malignant cystic breast lesions. Also, grading of the malignant lesions by using type of cystic breast mass cannot be applied.

Prepubertal unilateral gynecomastia and the presence of 47,XXY mosaicism in breast epithelial cells: a case report

Breast enlargement in prepubertal boys is a rare condition. This case report describes an otherwise healthy 3-year old non-obese boy who developed a large unilateral cystic breast mass measuring approximately 9 × 6 × 4cm. The mass was initially treated as a lymphatic malformation, and sclerotherapy with Picibanil® (OK-432) was attempted without any detectable effect on size. The mass was later excised. The pathological examination revealed mammary gland tissue suggestive of idiopathic gynecomastia. FISH revealed 47, XXY mosaicism in the abnormal breast epithelial cells, but not in peripheral blood lymphocytes.

Analysis of Breast Imaging Reporting and Data System Category 4 Complex Cystic Masses of the Breast: Do All the Complex Cystic Breast Masses Merit a Biopsy?

Analysis of Breast Imaging Reporting and Data System Category 4 Complex Cystic Masses of the Breast: Do All the Complex Cystic Breast Masses Merit a Biopsy?

Cystic hypersecretory ductal carcinoma of the breast: a rare cause of cystic breast mass

We present the case of a surgically confirmed, invasive, cystic hypersecretory ductal carcinoma (CHDC) of the breast in a 43-year-old woman. The initial sonography showed a complex cyst, which required a core biopsy; however, the diagnosis was delayed as the patient refused to undergo the biopsy and the cyst decreased in size, as seen on follow-up sonography. Excision biopsy was performed, and invasive CHDC was diagnosed after regrowth of the cystic lesion. Meticulous sonographic evaluation of a cystic breast mass is always important, and pathology confirmation must be considered if the lesion shows features suspicious for malignancy, as a CHDC could be the cause of a cystic breast mass.

Sonoelastographic Evaluation of Cystic Breast Masses

Sonoelastographic Evaluation of Cystic Breast Masses

Review of Breast Cancers That Can Mimic a Cystic Component: Ultrasonographic and Pathologic Correlations

differentiation of a cyst from a solid lesion (1, 2). Cystic breast lesions may be associated with numerous pathological entities, but malignant cystic breast masses are rare. Mixed cystic and solid carcinomas of the breast are uncommon findings and constitute 0.3% to 2.0% of all breast carcinomas (2, 3). There are three situations in which a cystic lesion can be associated with malignancy described as an invasion of a carcinoma into an area of cystic disease, cystic degeneration of a high-grade malignancy, and the presence of an intracystic papillary carcinoma (3). Berg et al. (2) described the sonographic and pathologic correlations of cystic lesions of the breast in which 23% (18/79) of the complex cystic masses were found to be malignant. It is suggested that 67% (12/18) of sonographically circumscribed cystic masses were malignant and that sonography may be helpful in identifying those circumscribed masses that merit a biopsy. A malignant cystic mass of the breast can be seen with a circumscribed margin on imaging. Circumscribed cancers of the breast are listed as infiltrating ductal carcinomas not otherwise specified (IDC-NOS), mucinous carcinomas, medullary carcinomas, papillary carcinomas, phyllodes tumors and adenoid cystic carcinomas (4). Imaging findings of various malignant cystic breast masses with pathological correlations are illustrated. Knowledge of the disease spectrum, as well as the characteristics of malignant cystic masses, may be helpful in the selection of whether to perform a biopsy as part of patient management. J Korean Soc Radiol 2011;64:273-279

Value of sonographically guided needle sampling of cystic versus solid components in the diagnosis of complex cystic breast masses

The common practice for diagnosis of complex cystic breast masses (CCBM) may be imaging-guided aspiration or biopsy of cystic or solid components. To assess the diagnostic value of sonographically guided needle sampling of cystic and solid components for CCBM. Twenty patients with 20 CCBM underwent sonographically guided fine-needle aspiration biopsy (FNAB) for cystic components, followed by core needle biopsy (CNB) for residual solid components. The diagnostic results of each were evaluated. Excisional biopsy or mastectomy served as a reference standard. Fourteen (70%) masses were malignant. Needle sampling for cystic components of the 14 malignant tumors showed malignancy in one (7%), atypia in four (29%), benign findings in four (29%), and insufficient samples in five (36%). Needle sampling for residual solid components showed malignancy in 11 (79%), atypia in two (14%), and insufficient sample in one (7%). The diagnostic yield of needle sampling of solid components was significantly higher than that of cystic components for malignant CCBM (P<0.05). Sixteen (80%) of 20 CCBMs showed bloody fine-needle aspirates. There was no significant difference between the rates of bloody aspirates of malignant and benign CCBM (86% vs. 67%, P=0.55). Sonographically guided needle sampling of solid components may help to identify most malignant CCBMs, and the aspirated fluid may be discarded due to low diagnostic value.

Complex Cystic Breast Masses: Diagnostic Approach and Imaging-Pathologic Correlation

Complex cystic breast masses demonstrate both anechoic (cystic) and echogenic (solid) components at ultrasonography (US). US is used to identify and characterize such masses and to guide percutaneous biopsy. Numerous pathologic entities may produce complex cystic breast lesions or may be associated with them, and biopsy is usually indicated. Common benign findings include fibrocystic changes, intraductal or intracystic papilloma without atypia, and fibroadenoma. Common atypical findings include atypical ductal hyperplasia, atypical papilloma, atypical lobular hyperplasia, and lobular carcinoma in situ. Malignant findings include ductal carcinoma in situ, infiltrating ductal carcinoma, and infiltrating lobular carcinoma. If the biopsy approach is tailored to the individual patient and if the imaging features are closely correlated with findings at pathologic analysis, US-guided percutaneous biopsy may be used effectively to diagnose and to guide management of complex cystic masses.

Kyste hydatique du sein de découverte fortuite

Hydatid cyst of the breast is rare even in areas of endemic echinococcosis. It accounts for 0.3% of all localizations and 2% of the uncommon sites. It can be isolated or associated with other localizations. We report the case of a hydatid breast cyst, associated with a pulmonary hydatid cyst, fortunately diagnosed by mammography and ultrasonography. Both cysts were removed. Hydatid breast cysts must be considered in any cystic breast mass, particularly in endemic countries.

Pathologic quiz case: a large, ill-defined cystic breast mass. Invasive cystic hypersecretory duct carcinoma.

Pathologic quiz case: a large, ill-defined cystic breast mass. Invasive cystic hypersecretory duct carcinoma.

Pathologic Quiz Case: A Large, Ill-Defined Cystic Breast Mass

Pathologic Quiz Case: A Large, Ill-Defined Cystic Breast Mass

Diagnosis and Treatment of Intracystic Breast Carcinomas

Cystic breast masses are very common in female patients attending breast clinics. Most of them are benign and managed by simple aspiration. We reviewed histology records for the last 12 years to find patients with cystic breast carcinomas and to evaluate special clinical signs that may help to identify patients with this rare entity. Eighteen patients with cystic breast carcinomas were found among 1510 new breast cancer patients (1.19%) who were seen at our Breast Unit during this period. Ten had intracystic papillary carcinoma (0.66% of all breast cancers), seven had cystic degeneration of ductal carcinoma, and one had a mucinous carcinoma. The diagnosis of intracystic papillary carcinoma was based on cyst fluid cytology and breast imaging in most patients and on open breast biopsy in two cases only. The prognosis of our cystic breast carcinoma patients was excellent regardless of the specific histologic type of the tumor. We conclude that cysts in postmenopausal women should be viewed with suspicion. Bloodstained aspirated cyst fluid should be sent for cytology and breast imaging should be carried out in all these cases. Residual mass after cyst aspiration is also an indication for open biopsy.