E4643. A Case-Based Approach to Management and Biopsy of Cystic Breast Masses: It’s Not All That Complex
  1. Sri Sannihita Vatturi; University of Ottawa
  2. Mary Beth Bissell; University of Ottawa
Breast cysts are a common entity and one of the most common reasons for referral to a Breast Center; however, management of cystic breast lesions that do not meet diagnostic criteria for a benign breast cyst can pose some challenges. This exhibit reviews the imaging spectrum of the more common cystic breast masses and provides a simple algorithm for management of these lesions, emphasizing the importance of clinical history.

Educational Goals / Teaching Points
Describe pertinent imaging features of cystic breast masses using the BI-RADS lexicon and understand which features necessitate biopsy. Provide a differential diagnosis for cystic breast masses and understand the importance of clinical presentation to management. Implement new procedural strategies to obtain adequate tissue for diagnosis in these often hard-to-biopsy lesions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will review the epidemiology and imaging appearances of simple, complicated, and complex cysts. Through cases we provide a multimodality imaging review (MG, US, and MRI) of the most common cystic breast masses including: galactocele, hematoma, fat necrosis, breast abscess, intracystic papilloma, and papillary carcinoma, as well as invasive breast cancer. Cases include corresponding pathology images to further the reader’s understanding of radiology-pathology concordance in these cases. The technical challenges of tissue sampling for these lesions are reviewed with cases highlighting some tips and tricks for successful vacuum-assisted and core biopsy.

Cystic breast lesions are a common entity encountered in breast imaging necessitating a clear understanding of management of these lesions. We provide a clear framework for diagnosis and management of cystic breast lesions through elucidating the imaging features, emphasizing the importance of clinical history, and providing insights into challenging biopsy techniques. By equipping radiologists with this comprehensive toolkit, this exhibit will enhance radiologists’ capacity to navigate the domain of cystic breast lesions.