title: Management of complex breast cysts.
abstract: OBJECTIVE
  This study was undertaken to evaluate the various strategies currently in use to manage complex cysts and specifically address the need for intervention.
  
  
  METHODS
  A review of 4562 breast sonograms obtained during an 18-month period revealed 308 complex cysts in 252 women. Data collected from review of patient records included the patient's age and risk factors for breast cancer, aspiration or biopsy results (or both), follow-up imaging studies, and management recommendations.
  
  
  RESULTS
  Management recommendations for complex cysts were 1-year follow-up in 13 patients, 6-month follow-up in 148, sonographically guided aspiration in 82, aspiration with possible core biopsy in 62, and excisional biopsy in three. No malignancies were diagnosed in the group treated with follow-up imaging, sonographically guided aspiration, or excisional biopsy. One malignancy, a papilloma with a 3-mm focus of ductal carcinoma in situ, was diagnosed in one of the patients who underwent core biopsy.
  
  
  CONCLUSIONS
  Of the lesions classified as complex cysts, the malignancy rate was 0.3% (1/308). This malignancy rate is lower than that for lesions classified as probably benign using mammographic criteria (i.e., for lesions classified as category 3 lesions using the Breast Imaging Reporting and Data System). Because the accepted standard practice for management of probably benign lesions is follow-up studies, the low yield of malignancy in this series suggests that complex cysts can be managed with follow-up imaging studies instead of intervention.
authors.affiliation: Department of Radiology, Northwestern University Medical School, Chicago, IL 60611, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Venta
authors.forename: J P
authors.initials: JP
authors.lastname: Kim
authors.forename: C E
authors.initials: CE
authors.lastname: Pelloski
authors.forename: M
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005348:Fibrocystic Breast Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010212:Papilloma / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D016217:Ultrasonography, Mammary