Breast cysts and how they are diagnosed

As a woman gets older, her breasts naturally develop cysts. These are usually simple cysts and not associated with breast cancer. They can be clearly seen on ultrasound.

How can you diagnose a cyst?

The triple test:

  • Clinical assessment: the lump usually has sharp borders and is firm. It is freely mobile over the overlying muscle and under the skin. Cysts may become large but can usually be felt once they are 2 cm in size.
  • Imaging: A cyst shows up as a clear circle on the mammogram. If there are multiple cysts, there may be some areas of calcification on the mammogram. These may cause confusion with pre-cancerous changes and should be removed if that is the problem.
  • Aspiration: If a needle is put in a cyst and the fluid aspirated (pulled out with a needle), the fluid is usually a yellow-green colour. If there is evidence that it is blood stained, the fluid should be sent off for examination under a microscope. The lump should disappear completely when the fluid has been removed.

When do you worry about a cyst?

  • If the fluid is blood stained
  • If the ultrasound shows there is a lump in the cyst
  • If there is still a lump after the fluid has been removed
  • If the lump comes back quickly and repeatedly after aspiration
  • If there are calcifications on the mammogram that look suspicious
  • If any of the tests suggest it is not a simple cyst

If in doubt the area should be removed.

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