6/4/2023 0 Comments The black masses pc shadowOn screening mammography, a 65-year-old woman was noted to have a circumscribed oval mass containing calcifications that were punctate and amorphous and changed appearance between ( A) CC and ( B) MLO views ( arrows). Over the 3-year study, cysts were seen in 48 (66%) of 73 women using estrogen compared with 489 (37.9%) of 1290 who were not ( P<.0001) (see Table 2). Among 1363 postmenopausal women in the ACRIN 6666 trial, 73 (5.4%) were using estrogen replacement therapy. Cysts were seen at some time during the 3-year study in 537 (39.4%) of 1363 postmenopausal women compared with 516 (65.1%) of 793 premenopausal women ( P<.0001) ( Table 2). In the first year of ACRIN 6666 trial, 406 (29.8%) of 1362 postmenopausal women were found to have cysts, decreasing to 298 (24.7%) of 1208 by year 3. 6 Based on the ACRIN 6666 experience, it seems that postmenopausal cysts are much more common. In postmenopausal women, cysts are more common in women on hormone replacement therapy 5, 6 and were reported in 6% of such women in 1 series. Being hormonally sensitive, cysts can fluctuate in size and number with the menstrual cycle, being most prominent in the premenstrual phase. Of the participants with simple cysts, nearly half (48%) had cysts in both breasts. 4 In the ACRIN 6666 protocol, cysts were seen in 998 (37.5%) of 2659 women in the first round of screening ultrasonography and in 1255 (47.1%) of 2662 participants over the 3 years. Simple cysts represented 25% of consecutive breast masses in the series by Hilton and colleagues. Ectopic breast tissue (tail of Spence) can extend into the axillary tail regions, but breast tissue and therefore cysts and other breast lesions are not usually found within the axillae proper.Ĭysts are the most common type of breast mass, with peak incidence between ages 35 and 50 years. Cysts can be isolated or diffuse and can occur in any quadrant. The latter is a tall, cuboidal, secretory epithelium and can make the inner wall of the cyst appear fuzzy on high-resolution ultrasonography. The epithelium can be bland or apocrine type. Simple cysts are epithelium-lined, fluid-filled, round or oval structures that are thought to occur secondary to obstructed ducts. A summary of studies reviewed after systematic literature search (PubMed, National Library of Medicine, on January 2, 2010) and associated reference standards are presented in Table 1. 3 The reference standard for a given lesion in the ACRIN protocol includes not only biopsy within the first year of follow-up or at least 11-month follow-up imaging but also any biopsy results for procedures performed through a minimum of 33 months of follow-up. 2 In the ACRIN protocol, women at high risk for breast cancer were screened annually with mammography and independent, physician-performed, freehand sonography for 3 years. In addition to reviewing the literature on such lesions, the authors present results from the American College of Radiology Imaging Network (ACRIN) 6666 protocol of screening breast ultrasonography. Increasing use of whole breast screening ultrasonography reveals many, otherwise occult, cystic lesions of the breast a thorough understanding of their imaging findings and management is important. Intradermal cysts, such as epidermal inclusion cysts and sebaceous cysts, are benign findings, which are not included in this review. Clustered microcysts are common benign findings in pre- and perimenopausal women, although short-interval surveillance may be appropriate for many such lesions in postmenopausal women, particularly if the lesion is new or rather small or deep (ie, diagnostic uncertainty). When multiple and bilateral complicated and simple cysts are present (ie, at least 3 cysts, with at least 1 in each breast), a benign, BI-RADS 2, assessment is usually appropriate. As an isolated finding, homogeneous complicated cysts can be classified as probably benign, BI-RADS 3, with intervention only considered if there is interval development or enlargement, if abscess is suspected, or if suspicious features develop. When the debris is homogeneous and hypoechoic, it is often difficult to distinguish a complicated cyst from a solid mass. Breast Imaging Reporting and Data System (BI-RADS) 1 2, findings. When the debris is mobile or a fluid-debris level is seen, complicated cysts can be dismissed as benign. Perhaps the most challenging are complicated cysts, that is, cysts with internal debris. Although many of these lesions can be dismissed as benign simple cysts, requiring intervention only for symptomatic relief, complex cystic and solid masses require biopsy. Masses due to cystic lesions of the breast are extremely common findings on mammography, ultrasonography, and magnetic resonance (MR) imaging.
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