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Complex Cystic and Solid Masses (US)
Wendie A. Berg, MD, PhD
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KEY FACTS

  • Terminology

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Mass with both cystic (anechoic) and solid (hypo-, iso-, or hyperechoic) components
          • Any of the following in isolation or combination
            • Intracystic mass
            • Thick-walled (≥ 0.5 mm), cystic mass
            • Thick septations (≥ 0.5 mm) within otherwise cystic mass
            • Predominantly cystic mass with solid component(s)
            • Predominantly solid mass with cystic (anechoic) areas
          • Distinguish from complicated cyst with debris
            • Circumscribed, oval mass with imperceptible wall, posterior enhancement
            • Homogeneous low-level echoes, mobile debris, or fluid-debris level

        IMAGING

        • Mammographic Findings

          • Ultrasonographic Findings

            • MR Findings

              • CT Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    • Image-Guided Biopsy

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Jales RM et al: Complex breast masses: assessment of malignant potential based on cyst diameter. J Ultrasound Med. 31(4):581-7, 2012
                                2. Hsu HH et al: Complex cystic lesions of the breast on ultrasonography: feature analysis and BI-RADS assessment. Eur J Radiol. 79(1):73-9, 2011
                                3. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                4. Tea MK et al: The validity of complex breast cysts after surgery. Am J Surg. 197(2):199-202, 2009
                                5. Cardenosa G: Ultrasound of cysts, cystic lesions, and papillary lesions. Ultrasound Clin. 1:617-29, 2007
                                6. Chang YW et al: Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med. 26(1):47-53, 2007
                                7. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                8. Shetty MK et al: Sonographic findings in focal fibrocystic changes of the breast. Ultrasound Q. 18(1):35-40, 2002
                                9. Yilmaz E et al: Differentiation of phyllodes tumors versus fibroadenomas. Acta Radiol. 43(1):34-9, 2002
                                10. Venta LA et al: Management of complex breast cysts. AJR Am J Roentgenol. 173(5):1331-6, 1999
                                11. Soo MS et al: Fat necrosis in the breast: sonographic features. Radiology. 206(1):261-9, 1998
                                12. Warner JK et al: Apocrine metaplasia: mammographic and sonographic appearances. AJR Am J Roentgenol. 170(5):1375-9, 1998
                                13. Liberman L et al: Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 198(1):121-4, 1996
                                14. Omori LM et al: Breast masses with mixed cystic-solid sonographic appearance. J Clin Ultrasound. 21(8):489-95, 1993
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Top Differential Diagnoses

                                    • Clinical Issues

                                      TERMINOLOGY

                                      • Definitions

                                        • Mass with both cystic (anechoic) and solid (hypo-, iso-, or hyperechoic) components
                                        • Any of the following in isolation or combination
                                          • Intracystic mass
                                          • Thick-walled (≥ 0.5 mm), cystic mass
                                          • Thick septations (≥ 0.5 mm) within otherwise cystic mass
                                          • Predominantly cystic mass with solid component(s)
                                          • Predominantly solid mass with cystic (anechoic) areas
                                        • Distinguish from complicated cyst with debris
                                          • Circumscribed, oval mass with imperceptible wall, posterior enhancement
                                          • Homogeneous low-level echoes, mobile debris, or fluid-debris level

                                      IMAGING

                                      • Mammographic Findings

                                        • Ultrasonographic Findings

                                          • MR Findings

                                            • CT Findings

                                              • Nuclear Medicine Findings

                                                • Imaging Recommendations

                                                  • Image-Guided Biopsy

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Jales RM et al: Complex breast masses: assessment of malignant potential based on cyst diameter. J Ultrasound Med. 31(4):581-7, 2012
                                                              2. Hsu HH et al: Complex cystic lesions of the breast on ultrasonography: feature analysis and BI-RADS assessment. Eur J Radiol. 79(1):73-9, 2011
                                                              3. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                                              4. Tea MK et al: The validity of complex breast cysts after surgery. Am J Surg. 197(2):199-202, 2009
                                                              5. Cardenosa G: Ultrasound of cysts, cystic lesions, and papillary lesions. Ultrasound Clin. 1:617-29, 2007
                                                              6. Chang YW et al: Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med. 26(1):47-53, 2007
                                                              7. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                                              8. Shetty MK et al: Sonographic findings in focal fibrocystic changes of the breast. Ultrasound Q. 18(1):35-40, 2002
                                                              9. Yilmaz E et al: Differentiation of phyllodes tumors versus fibroadenomas. Acta Radiol. 43(1):34-9, 2002
                                                              10. Venta LA et al: Management of complex breast cysts. AJR Am J Roentgenol. 173(5):1331-6, 1999
                                                              11. Soo MS et al: Fat necrosis in the breast: sonographic features. Radiology. 206(1):261-9, 1998
                                                              12. Warner JK et al: Apocrine metaplasia: mammographic and sonographic appearances. AJR Am J Roentgenol. 170(5):1375-9, 1998
                                                              13. Liberman L et al: Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology. 198(1):121-4, 1996
                                                              14. Omori LM et al: Breast masses with mixed cystic-solid sonographic appearance. J Clin Ultrasound. 21(8):489-95, 1993