SONOGRAPHICALLY DIAGNOSED COMPLEX OR COMPLICATED BREAST CYST WITH HISTOPATHOLOGICAL CORRELATION TO SPECIFICALLY ADDRESS THE NEED FOR INTERVENTION

Abstract

Objective: This study was undertaken to find out the histological basis for sonographically diagonosed complex or complicated breast cyst and to specifically address the need for intervention based on sonographic features. Methods: From a retrospective review of 350 ultrasound guided breast interventions during two year period, 62 procedures were selected which were performed for complex breast cysts in 54 patients. Mean lesion size was 22mm. Diagnosis was established with fine needle aspiration under ultrasound guidance, core needle biopsy or excisional biopsy for small cyst after ultrasound guided bracketing in 34, 10 and 18 patients respectively. Results: Out of these 62 lesions, 50 lesions were characterized as thin walled cysts with fine internal echoes and thin septations sonologically. None proved malignant on cytology. 7 lesions were thick walled cysts with internal septation > 5mm, which on histopathology turned out to be either infected galactocoele (n=1) or breast abscesses (n=6). 5 lesions were solid cum cystic masses with cystic predominance, 4of these were malignant, and one was fibroadenoma with cystic change. In malignant lesions three were invasive ductal carcinomas grade 3 and one was lobular carcinoma. Conclusion: Complex cyst with thin wall and low-level internal echoes and thin internal septation with septal thickness less than 3mm are mostly benign and need short term follow up. However, Complex cystic masses with thick indistinct wall and thick septation or solid cum cystic masses with eccentric cystic foci should be biopsied. KEY WORDS: Breast Cyst, Ultrasound, Intervention