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Complicated Cyst With Debris (US)
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Imaging

    • Clinical Issues

      • Diagnostic Checklist

        TERMINOLOGY

        • Synonyms

          • Proteinaceous cyst
        • Definitions

          • Cyst containing internal echoes on US, thought to represent proteinaceous, fatty, or even cellular debris (e.g., blood or pus) but lacking any solid component
          • Not to be confused with complex cystic and solid mass
            • Complex features include any or all of following: Thick (≥ 0.5 mm) wall, thick septations, intracystic mass (e.g., mural nodule), mixed solid and cystic component(s)
            • Suspicious unless fatty mass on mammography &/or known to be due to trauma or surgery
          • If subsequently shown to be oil cyst on mammography, it should be so described

        IMAGING

        • General Features

          • Mammographic Findings

            • Ultrasonographic Findings

              • MR Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    • Image-Guided Biopsy

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  Selected References

                                  1. Jang JY et al: Clinical significance of interval changes in breast lesions initially categorized as probably benign on breast ultrasound. Medicine (Baltimore). 96(12):e6415, 2017
                                  2. Kim SY et al: Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts. Medicine (Baltimore). 95(44):e5279, 2016
                                  3. Berg WA et al: Quantitative maximum shear-wave stiffness of breast masses as a predictor of histopathologic severity. AJR Am J Roentgenol. 205(2):448-55, 2015
                                  4. Berg WA et al: Technologist-performed handheld screening breast US imaging: how is it performed and what are the outcomes to date? Radiology. 272(1):12-27, 2014
                                  5. Berg WA et al: Multiple bilateral circumscribed masses at screening breast US: Consider annual follow-up. Radiology. 268(3):673-83, 2013
                                  6. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                  7. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                  8. Daly CP et al: Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy? Acad Radiol. 15(5):610-7, 2008
                                  9. Chang YW et al: Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med. 26(1):47-53, 2007
                                  10. Berg WA et al: Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology. 241(2):355-65, 2006
                                  11. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                  12. Szopinski KT et al: Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. 22(5):479-87; quiz 488- 9, 2003
                                  13. Gizienski TA et al: Breast cyst recurrence after postaspiration injection of air. Breast J. 8(1):34-7, 2002
                                  14. Kolb TM et al: Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology. 225(1):165-75, 2002
                                  15. Buchberger W et al: Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography. Semin Ultrasound CT MR. 21(4):325-36, 2000
                                  16. Hindle WH et al: Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts. Am J Obstet Gynecol. 182(6):1300-5, 2000
                                  17. Venta LA et al: Management of complex breast cysts. AJR Am J Roentgenol. 173(5):1331-6, 1999
                                  18. Kolb TM et al: Occult cancer in women with dense breasts: detection with screening US--diagnostic yield and tumor characteristics. Radiology. 207(1):191-9, 1998
                                  19. Bodian CA et al: The epidemiology of gross cystic disease of the breast confirmed by biopsy or by aspiration of cyst fluid. Cancer Detect Prev. 16(1):7-15, 1992
                                  20. Ciatto S et al: The value of routine cytologic examination of breast cyst fluids. Acta Cytol. 31(3):301-4, 1987
                                  21. Dixon JM et al: Natural history of cystic disease: the importance of cyst type. Br J Surg. 72(3):190-2, 1985
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Imaging

                                    • Clinical Issues

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Synonyms

                                          • Proteinaceous cyst
                                        • Definitions

                                          • Cyst containing internal echoes on US, thought to represent proteinaceous, fatty, or even cellular debris (e.g., blood or pus) but lacking any solid component
                                          • Not to be confused with complex cystic and solid mass
                                            • Complex features include any or all of following: Thick (≥ 0.5 mm) wall, thick septations, intracystic mass (e.g., mural nodule), mixed solid and cystic component(s)
                                            • Suspicious unless fatty mass on mammography &/or known to be due to trauma or surgery
                                          • If subsequently shown to be oil cyst on mammography, it should be so described

                                        IMAGING

                                        • General Features

                                          • Mammographic Findings

                                            • Ultrasonographic Findings

                                              • MR Findings

                                                • Nuclear Medicine Findings

                                                  • Imaging Recommendations

                                                    • Image-Guided Biopsy

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  Selected References

                                                                  1. Jang JY et al: Clinical significance of interval changes in breast lesions initially categorized as probably benign on breast ultrasound. Medicine (Baltimore). 96(12):e6415, 2017
                                                                  2. Kim SY et al: Application of the downgrade criteria to supplemental screening ultrasound for women with negative mammography but dense breasts. Medicine (Baltimore). 95(44):e5279, 2016
                                                                  3. Berg WA et al: Quantitative maximum shear-wave stiffness of breast masses as a predictor of histopathologic severity. AJR Am J Roentgenol. 205(2):448-55, 2015
                                                                  4. Berg WA et al: Technologist-performed handheld screening breast US imaging: how is it performed and what are the outcomes to date? Radiology. 272(1):12-27, 2014
                                                                  5. Berg WA et al: Multiple bilateral circumscribed masses at screening breast US: Consider annual follow-up. Radiology. 268(3):673-83, 2013
                                                                  6. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                                  7. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                                                  8. Daly CP et al: Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy? Acad Radiol. 15(5):610-7, 2008
                                                                  9. Chang YW et al: Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med. 26(1):47-53, 2007
                                                                  10. Berg WA et al: Operator dependence of physician-performed whole-breast US: lesion detection and characterization. Radiology. 241(2):355-65, 2006
                                                                  11. Berg WA et al: Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 227(1):183-91, 2003
                                                                  12. Szopinski KT et al: Tissue harmonic imaging: utility in breast sonography. J Ultrasound Med. 22(5):479-87; quiz 488- 9, 2003
                                                                  13. Gizienski TA et al: Breast cyst recurrence after postaspiration injection of air. Breast J. 8(1):34-7, 2002
                                                                  14. Kolb TM et al: Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology. 225(1):165-75, 2002
                                                                  15. Buchberger W et al: Clinically and mammographically occult breast lesions: detection and classification with high-resolution sonography. Semin Ultrasound CT MR. 21(4):325-36, 2000
                                                                  16. Hindle WH et al: Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts. Am J Obstet Gynecol. 182(6):1300-5, 2000
                                                                  17. Venta LA et al: Management of complex breast cysts. AJR Am J Roentgenol. 173(5):1331-6, 1999
                                                                  18. Kolb TM et al: Occult cancer in women with dense breasts: detection with screening US--diagnostic yield and tumor characteristics. Radiology. 207(1):191-9, 1998
                                                                  19. Bodian CA et al: The epidemiology of gross cystic disease of the breast confirmed by biopsy or by aspiration of cyst fluid. Cancer Detect Prev. 16(1):7-15, 1992
                                                                  20. Ciatto S et al: The value of routine cytologic examination of breast cyst fluids. Acta Cytol. 31(3):301-4, 1987
                                                                  21. Dixon JM et al: Natural history of cystic disease: the importance of cyst type. Br J Surg. 72(3):190-2, 1985