16 Year Experience with Aspiration of NonComplex Breast Cysts: Cytology Results with Focus on Positive Cases
The Breast Journal, 08/01/2012
Exclusive author commentary
Sanders L.M et al. – This is a retrospective review of 5375 aspirations performed during the last 16 years of noncomplex cysts. It was seen that noncomplex cysts are benign 99% of the time. Cysts with papillary cytology require no further workup. Margin–negative seromas do not require cytologic analysis of fluid. Sixteen malignancies were revealed (0.3%), eight of which were solitary cysts (0.1%). Atypical cytology predicted malignancy in 21%; therefore, atypical cytology requires further workup. Malignant cytology was associated with breast cancer in 90.9% of patients; therefore, all patients with malignant cytology require biopsy.
Linda M. Sanders (08/04/2012) comments:
My data indicate 99% benignity of noncomplex cysts. To those performing this procedure: be cautious. Do not interpret this fact as license to pass all lesions interpreted as complicated cysts. Sometimes it is difficult to know in advance whether a small lesion is a cyst or solid and the only way to be sure is to perform an aspiration. Not included in this review are the numerous lesions which were hypoechoic on ultrasound and thought to be cysts, but which were, in fact, solid. The misinterpretation of hypoechoic solid lesions as cysts is not infrequent, particularly among the newly trained or casual readers of breast ultrasound. The data in this review will give the breast interventionalist statistical information to convey to the patient following the cyst aspiration procedure. It is reassuring to the patient that her cyst has a 99% likelihood of benignity. The issue of whether to send the fluid or not I will leave to each individual practicing physician. Dr. Linda M. Sanders