• 05Apr

    Can benign cysts in breast become dangerous?

    A cyst is a cavity containing fluid and its surface is lined with epithelium. One in twelve women develops symptoms due to breast cysts in their lifetime. Cysts occur most commonly in the later part of reproductive life. They form during the involution of the breast tissue in the premenopausal period. Breast tissue is composed of two main components – the epithelial tissue which produces milk and the supporting tissue or the stroma. A lack of integrated involution of the stroma and epithelium results in the formation of breast cysts.


    A breast cyst can be simple or a complex cyst. A simple cyst has a solitary cavity and is lined with epithelium. The complex cyst has multiple compartments in the cyst due to septae or has a combined solid (tumor) and cystic components. The complex cyst has a high risk of cancer. They are often multiple, may be bilateral and can mimic malignancy. They may present suddenly with or without pain and cause great concern.

    Breast cysts are also associated with fibrocystic disease. They appear in the second half of the menstrual cycle and are associated with discomfort or pain. These symptoms subside after menopause. Galactocele is a cyst which contains milk. It may occur during the period of lactation and is a benign condition.  In longstanding cases its walls tend to calcify and are seen in the mammograms.

    Breast cysts are a common cause for concern in women.

    Breast cysts are a common cause for concern in women.

    Diagnosis

    A prompt diagnosis and drainage of its contents provides quick relief. A small cyst is not palpable clinically and requires imaging for detection. Diagnosis of a cyst can be confirmed by aspiration, and ultrasound. Though mammography can also identify cysts, in some cases it may be difficult to differentiate solid from cystic lesions. On ultrasound, they appear round or oval shaped spaces. Ultrasound is more sensitive technique than mammography for diagnosis of breast cysts. The accuracy of sonography in detecting cysts has been reported in various studies as 95% to 100%. With high resolution imaging, cysts as small as 2 – 3 mm can be detected. The sonography can show whether it is a simple cyst or a complex cyst. It can also show if there is a solid nodule or tumor associated with the cyst. The risk of cancer in complex cyst is about 0.3%. This is an indication for biopsy to rule out cancer.

    Breast ultrasonography is an office procedure. A hand-held probe is used over the breasts after the application of gel. The images are seen on a monitor. The procedure is painless and requires a short duration.

    Treatment

    A single or few cysts are aspirated using a syringe and a needle under local anesthesia. Cysts which are located deeper may require the use of ultrasound guided aspiration. If the aspirated fluid is blood stained, there is a suspicion of cancer. The fluid is sent for microscopic examination to look for cancer cells. If they resolve completely after aspiration no further treatment is required. However, in about 30% of women they recur and require second aspiration. If a lump persists even after aspiration, a wide-bore needle biopsy is done to rule out cancer. In cases where the cyst reappears after multiple aspirations, this needs to be excised surgically. This is done so as to find out a cystic form of breast cancer called cystadenocarcinoma, which is a type of breast cancer in elderly women.

    Breast cysts are a common cause for concern in women. Since they occur in the fourth and fifth decades of life, they raise concerns about the occurrence of cancer. The opinion of the physician should be taken regarding its management and follow-up as appropriate.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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