Clustered Microcysts at Breast US: Outcomes and Updates for Appropriate Management Recommendations.

Background Clustered microcysts are common, especially in perimenopausal women, and are seen in up to 6% of US examinations. However, there are limited published data on appropriate assessment and management recommendations for clustered microcysts on breast US images. Purpose To determine outcomes of lesions identified as clustered microcysts on breast US images to help guide appropriate management recommendations. Materials and Methods Lesions classified as clustered microcysts at breast US were retrospectively identified in women at two hospitals (a large tertiary care academic hospital and a National Comprehensive Cancer Network-designated comprehensive cancer center) within one metropolitan health system from 2005 through 2015. If US-guided tissue sampling was performed, results were obtained from the pathology or cytology reports. If sampling was not performed, only lesions with at least 24 months of imaging follow-up or any imaging follow-up with interval resolution or decrease in size were included in the study. Data were evaluated using standard statistics, Fisher exact tests, and Wilcoxon rank sum tests. Results A total of 189 women (median age, 52 years [interquartile range, 46-59 years]) with 196 lesions classified as clustered microcysts on US images were included in this study. During the surveillance period of at least 24 months and at tissue diagnosis, malignancy was not found in any of the 196 lesions (0%) (95% confidence interval: 0.0%, 1.9%). A total of 158 of 196 (80%) lesions were followed with imaging, and 38 of 196 (20%) lesions underwent percutaneous sampling. During the follow-up period, 28 of 158 (18%) lesions spontaneously resolved, 13 of 158 (8%) decreased in size, and one of 158 lesions (0.6%) increased at 18-month follow-up but then became stable. One hundred sixteen of 158 lesions (73%) demonstrated no change at follow-up imaging, 38 of 196 (19%) lesions underwent percutaneous sampling, and 38 of 38 (100%) revealed benign results. Conclusion No malignancies were identified in this series. These results further support the existing literature that lesions characterized as clustered microcysts demonstrate a very low risk of malignancy and can be classified as benign. Biopsy may be safely avoided. © RSNA, 2020 See also the editorial by Berg in this issue.

Effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts.

PURPOSE: We aimed to evaluate the effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts. METHODS: From January 2002 to January 2014, 35 simple breast cysts (mean volume, 8.2 mL; range, 4-33 mL) in 28 females (mean age, 39 years) were evaluated. In a single session, all cysts were aspirated using 20G needles, refilled with 99% ethanol (90% of the volume of the aspirated fluid), and reaspirated completely after 10 minutes of exposure under ultrasound guidance. Follow-up ultrasonography examinations were performed at one week, one month, three months, and six months for all patients and 12 months, 18 months, and 24 months for available patients. Follow- up duration varied between 6 and 24 months (mean, 15 months). RESULTS: The technical success rate of ultrasound-guided percutaneous etha-nol sclerotherapy was 97%. The needle tip was dislocated and ethanol was given into the breast parenchyma in one patient (3%). One cyst (3%) was reaspirated at the first week follow-up due to intracystic hemorrhage. Of the 34 cysts treated, 25 (74%) completely responded to therapy and were no longer detectable on follow-up examinations. Eight cysts (24%) significantly decreased in size and then completely disappeared at six months. At the end of the follow-up period, the clinical success rate reached 100%, and none of the cysts were visible. Except mild to moderate sensation of burning or pain which disappeared or subsided significantly in a couple of minutes, no other complications were observed in patients. CONCLUSION: Ultrasound-guided ethanol sclerotherapy is a fast, safe, and highly effective method in the treatment of simple breast cysts.

Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF): benign breast tumors - short text.

Screening with breast ultrasound in combination with mammography is needed to investigate a clinical breast mass (Grade B), colored single-pore breast nipple discharge (Grade C), or mastitis (Grade C). The BI-RADS system is recommended for describing and classifying abnormal breast imaging findings. For a breast abscess, a percutaneous biopsy is recommended in the case of a mass or persistent symptoms (Grade C). For mastalgia, when breast imaging is normal, no MRI or breast biopsy is recommended (Grade C). Percutaneous biopsy is recommended for a BI-RADS category 4-5 mass (Grade B). For persistent erythematous nipple or atypical eczema lesions, a nipple biopsy is recommended (Grade C). For distortion and asymmetry, a vacuum core-needle biopsy is recommended due to the risk of underestimation by simple core-needle biopsy (Grade C). For BI-RADS category 4-5 microcalcifications without any ultrasound signal, a minimum 11-G vacuum core-needle biopsy is recommended (Grade B). In the absence of microcalcifications on radiography cores additional samples are recommended (Grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial atypia, radial scar and mucocele with atypia, surgical excision is commonly recommended (Grade C). Expectant management is feasible after multidisciplinary consensus. For these lesions, when excision margins are not clear, no new excision is recommended except for LCIS characterized as pleomorphic or with necrosis (Grade C). For grade 1 phyllodes tumor, surgical resection with clear margins is recommended. For grade 2 phyllodes tumor, 10mm margins are recommended (Grade C). For papillary breast lesions without atypia, complete disappearance of the radiological signal is recommended (Grade C). For papillary breast lesions with atypia, complete surgical excision is recommended (Grade C).

[Lactation after breast plastic surgery: literature review]. / Montée laiteuse après chirurgie plastique du sein: revue de la littérature.

The occurrence of lactation is a rare complication of breast plastic surgery. During the course of his practice, the plastic surgeon will probably encounter this complication. The goal of this article is to carry out a literature review of all published galactorrhea and/or galactocele cases following a breast-reduction or a breast-augmentation, representing a total of 34 cases reported in 21 articles. The physiopathology of this complication is linked to an inappropriate secretion of prolactin in a surgical context. The factors favoring this complication would be the number of pregnancies, a history of recent and extensive nursing, and the intake of certain medicines such as an oestro-progestative pill. The main symptom of this complication is the occurrence of a uni- or bilateral galactorrhea, on average 12.6 days after the surgery. The main differential diagnosis is a postoperative infection. The explorations presented a hyperprolactinemia in 69% of cases. No biological inflammatory syndrome was reported. A fluid collection evoking a galactocele was visible on the ultrasound in 65% of cases. One case of prolactin-secreting pituitary adenoma was reported. Depending on the case, the treatment varied from a simple surveillance to the association of a dopamine agonist, an antibiotic therapy, and a surgical revision. A diagnostic and therapeutic management strategy is proposed.

Usefulness of contrast-enhanced ultrasonography for intracystic breast tumors: a report of three cases.

Cystic breast lesions are caused by a wide spectrum of breast diseases and can range from simple cysts to malignant tumors. Ultrasonography is a good tool for evaluation of the morphology and vascularity of cystic breast lesions. We report three patients in whom contrast-enhanced ultrasonography (CEUS) was used to evaluate intracystic tumors. One of the three patients was diagnosed with intracystic papilloma. Compared with conventional ultrasonography alone, CEUS more clearly demonstrated that the solid component within the mass was lobulated with a narrow base. The other two patients were diagnosed with intracystic papillary carcinoma, and CEUS clearly revealed the presence of widely elevated solid components within both masses, suggesting malignancy. Therefore, CEUS simplified morphological evaluation by enhancing the solid components within the cystic masses.

Postaugmentation galactocele: a case report and review of literature.

Galactorrhea and galactoceles are relatively uncommon complications after breast augmentation surgery, but should be considered in the differential of an enlarged breast. We present a case of a 34-year-old woman who had a remote history of bilateral breast augmentation and developed a unilateral galactocele while breast-feeding. She subsequently underwent an incision and drainage, as well as medical management with bromocriptine. Her galactocele resolved adequately with this treatment. Surgeons performing breast augmentation should be aware of the clinical presentation as well as the treatment options for this entity.

Estudios percutáneos de mama: punción aspirativa con aguja fina / Percutaneous studies of the breast: fine needle aspiration

Procedimiento de diagnóstico de patologías benignas y malignas, del que se describe su uso en diagnósticos citológicos, aspiración diagnóstica y/o sintomatológica de quistes y/o formaciones líquidas, instilación de antibióticos en cavidades abscedadas, e instilación de contrastes en ductos.

Cistos mamários - qual o seu significado? / Breast cysts - what do they mean?

Os cistos fazem parte de uma variedade de alterações benignas da mama, designadas como mudanças fibrocísticas, e constituem uma das causas mais freqüentes de tumores mamários. O exame clínico, isoladamente, é incapaz de estabelecer o diagnóstico de um cisto mamário. Geralmente é uma lesão assintomática, sendo diagnosticada por métodos de imagem. A acurácia do ultra-som para a identificação de cistos é próxima dos 100 porcento quanto presente massa anecóica oval, redonda ou lobulada, de contorno circunscrito, com reforço acústico posterior. Segundo o sistema BI-RADS para ultra-sonografia, os cistos podem ser divididos em simples, microcistos agrupados, complicados e complexos, sendo classificados em : categoria 2 (benigna) os cistos simples, categoria 3 (provavelmente benigna) para os microcistos agrupados e os cistos complicados e categoria 4 (suspeita) para os cistos complexos. A abordagem terapêutica dos cistos mamários deve ser individualizada de acordo com sua apresentação e o perfil psicológico de cada paciente. Atualmente, não se justificam medidas radicais na abordagem terapêutica destas lesões, visto que sua natureza é eminentemente benigna. É mister que os ginecologistas e mastologistas estejam informados e atualizados para utilizar racionalmente os recursos propedêuticos, otimizando tanto o benefício psíquico e clínico das pacientes como os custos decorrentes de exames e terapêuticas desnecessárias na abordagem dos diferentes tipos de cistos mamários.

Management of benign breast conditions. Part 2--breast lumps and lesions.

This is the second article in a series on breast disorders with an emphasis on diagnosis and management in the general practice setting. This article provides an overview of the investigation of patients with a breast symptom and discusses the assessment and management of benign breast lesions including localised nodularity, fibroadenomas and breast cysts.

Approach to a lump in the breast: a regional perspective.

The clinical presentation, investigation and treatment of women with breast lumps are greatly influenced by geographical factors. These impact disease patterns and their presentation (e.g. socioeconomic/educational status and cultural/religious beliefs) and the availability of specialist health care personnel and facilities. The differential diagnoses of a breast lump include breast cancer, benign solid and cystic lumps and inflammatory conditions. The likelihood of a diagnosis relates more to geographical area, age, ethnic origin, family history of breast cancer, presence of high-risk pathology, endemic infection, smoking, pregnancy and lactation history, puerperal care and health education. Investigations and treatments vary more according to the availability of expertise and facilities (e.g. combined diagnostic clinic staffed by breast surgeon and radiologist; breast radiologist to carry out image-guided diagnostic and therapeutic procedures). This article discusses the clinical assessment and investigation of breast lumps and possible treatments from an Asia Pacific perspective.

[Types of therapeutic-and-diagnostic policy for breast cystic masses]. / Varianty lechebno-diagnosticheskoi taktiki pri kistoznykh obrazovaniiakh molochnykh zhelez.

The experience gained with diagnosing and treating 228 females aged 20 to 68 years who had breast cysts has shown that its diagnosis is verified by a combination of ultrasonography, mammography, and aspiration fine-needle biopsy. The use of needle pneumoethanol therapy permits effective cure.