Breast cysts: Clinical manifestations, diagnosis, and management
- Christine Laronga, MD, FACS
Christine Laronga, MD, FACS
- Moffitt Cancer Center, University of South Florida
- Sharon Tollin, PhD, ARNP, AOCNP
Sharon Tollin, PhD, ARNP, AOCNP
- Nurse Practitioner
- Lifetime Cancer Screening & Prevention Center
- Blaise Mooney, MD
Blaise Mooney, MD
- Assistant Professor
- Moffitt Cancer Center
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
A breast cyst is a fluid-filled round or ovoid mass derived from the terminal duct lobular unit (TDLU) (image 1). Cysts begin as fluid accumulation in the TDLU because of distension and obstruction of the efferent ductule . (See "Breast development and morphology", section on 'Lobule formation'.)
Breast cysts, which can present as a solitary mass or multiple masses, usually prompt women to seek medical attention because of the palpable mass or associated pain or discomfort. A breast cyst may be first identified on a clinical or self-breast examination, or as a mammographic density. Breast cysts may fluctuate in size, number, and magnitude of symptoms.
Breast cysts are influenced by hormonal function and fluctuation. Therefore, they occur during lobular development, menstrual cyclic changes, and lobular involution in premenopausal and perimenopausal women .
Breast cysts are common masses found in premenopausal, perimenopausal, and postmenopausal women. In a prospective study of 2809 women at increased risk of breast cancer development, the American College of Radiology Imaging Network (ACRIN) 6666 protocol found that cysts were identified in 37.5 percent of all women screened, with the peak incidence between 35 and 50 years of age . During this three-year screening study, cysts were identified more often in premenopausal women compared with postmenopausal women (65.1 versus 39.4 percent). Hormone replacement therapy (HRT) was used by 5.4 percent (n = 73) of postmenopausal women, and 66 percent of HRT users were diagnosed with cysts.
Symptomatic and asymptomatic small cysts (microcysts) are common in young premenopausal women . (See "Overview of benign breast disease", section on 'Nonproliferative breast lesions' and "Clinical manifestations and diagnosis of a palpable breast mass", section on 'Benign'.)
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- CLINICAL FEATURES
- Patient presentation
- Physical examination findings
- - Ultrasonography
- - Simple
- - Complicated
- - Complex
- BI-RADS categories
- Risk of malignancy
- - Mammography
- - MRI
- DIFFERENTIAL DIAGNOSIS
- Simple cyst
- Complicated cyst
- Complex cyst
- SUBSEQUENT BREAST CANCER RISK
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS