I often encounter such patients in the mammography clinic, coming in with an anxious face and saying in a panic: “Dr. Zhu, yesterday, I had a place in my breast that was very painful, and a lump, quite hard, scared me to death”. As a senior mammographer I will be muttering in my heart: long cysts?
What is a breast cyst?
Breast cysts are one of the most common disorders seen in mammography clinics. About 7-10% of women of childbearing age have cysts in their breasts, with a peak incidence between the ages of 40 and 50, and a rapid decline in incidence after menopause.
Most of the breast cysts are anomalies in the normal development and degeneration of the breast (ANDI) – to be precise, they are anomalies in the degeneration of the normal lobules and are not considered a disease, as the normal degeneration of the epithelial tissue of the lobules depends on the persistence of the specific mesenchyme around them. If the nipple mesenchyme disappears too early, the epithelial vesicles may form tiny cysts, or if the milk ducts are blocked, they may develop into large cysts.
What causes breast cysts? What should I pay attention to in my daily diet?
Some indirect evidence confirms that high estrogen expression is a direct or related cause of the disease, such as the application of estrogenic drugs to improve menopausal symptoms in women older than 50 years old as a cause of cyst formation.
The usual diet should pay attention to reduce the intake of high-protein and high-estrogen foods and drugs, such as seafood, Xueha, royal jelly, pollen, birth control pills and sheep placenta.
What are the symptoms of breast cysts? How to make a clear diagnosis?
Patients often find a lump when they touch their breast unintentionally or with breast pain. The lump feels smooth, movable and cystic on the surface, however, if the pressure inside the cyst is high, it will feel harder and resemble a solid tumor. Some patients may notice a large cyst in the breast only because of a sudden increase in pressure within the capsule or sudden pain due to chemical inflammation caused by extravasation of fluid from the capsule.
Ultrasound and fine needle aspiration help to make a definite diagnosis.
Ultrasound of the breast shows single or multiple anechoic areas in one or both mammary glands of the patient. The anechoic areas appear as round or ovoid with clear borders, thin and smooth walls, good sound transmission, or sometimes separated bands of light with enhanced or no posterior echogenicity. The ultrasound image of cysts becomes atypical (ultrasonographers call them complex cysts) when extravasation of cystic fluid causes inflammatory reaction of surrounding tissues. Breast cysts should be differentiated from solid occupying lesions.
How are cysts found treated?
Most cysts are currently treated by ultrasound-guided or direct cyst aspiration, and more often by close follow-up.
If the fluid in the cyst is bloody to the naked eye after aspiration (Figure A), cytological examination of the cystic fluid is required. If the fluid is not bloody (Figure B), cytological examination of the cystic fluid is chosen in conjunction with the physician’s clinical considerations or the patient’s wishes, and if the cytological findings suggest cellular anomalies, suspicious malignancy or malignancy, an excisional biopsy of the mass is subsequently performed.
If ultrasonography reveals the presence of a solid occupancy within the cyst, ultrasound-guided core puncture biopsy of the solid area is required along with cyst fluid cytology.
More women with breast cysts opt for close follow-up, which includes a clinical examination by a specialist and a breast ultrasound, plus a high-frequency mammogram in women over 35 years of age, mainly to rule out incidental breast cancer.
Although cysts are a nuisance, they hardly cause any associated lesions and it is important to clarify that although cysts may increase the risk of breast cancer, they are not precancerous in themselves, so surgical removal is not necessary.
Breast cysts
Breast cyst is a disorder, not considered a disease, in the development and degeneration of the breast.
Breast ultrasound and fine needle aspiration can basically make a definite diagnosis of breast cysts.
cytological testing is required when the intracapsular fluid of a breast cyst is extracted as a hemorrhagic fluid
the presence of a solid area within the cyst on ultrasound requires ultrasound-guided core puncture biopsy of the solid area
breast cysts themselves are not precancerous and basically do not require surgical excisional biopsy
Although the risk of breast cysts increasing the prevalence of breast cancer is small, it is important for women to receive routine breast examinations at follow-up, which are used to rule out incidental breast cancer.