The comparison radiologic and pathologic findings in complex cystic lesions of the breast

Complex cystic lesions of the breast are suspect for malignancy. In our study, we reviewed the radiological findings and pathological evaluations of complex breast cysts that were detected by our department and had pathology reports. We aimed to determine the mammographic and sonographic features of complex cystic lesions that predicted and favored malignancy. Records of 1578 patients that underwent fine needle aspiration biopsy, excisional biopsy after either sonography or mammography guided wire localization, or core/vacuum biopsy under sonography between January 2004 - December 2012 were examined. The cysts that demonstrated thick wall and/or thick septae, solid component (mural nodule and/or a predominantly cystic solid component) or more than one sonographic feature combined (multiple sonographic finding) were defined as complex cysts. A total of 66 complex cystic lesions in 61 patients were included in the study. Positive predictive value (%PPD) was calculated for each sonographic and mammographic finding. The analysis of sonographic and mammographic findings in relation to malignancy was done with Pearson chi-square test and Fishers? Exact test. All results of a p value of less than 0.05 were considered statistically significant. Out of a total of 66 complex breast cysts, 28 (42%) had thick walls and/or septae; and 38 (58%) had solid components. The most common finding in mammography was mass with well-defined margins. Six masses seen on mammography had microcalcification additionally. Histopathological evaluation of 66 lesions revealed 56 (85%) benign and 10 (15%) malign lesions. Malign lesions included 4 invasive ductal carcinomas, 4 intraductal papillary carcinomas and 2 mucinous carcinomas. The most common benign results were fibrocystic change, fat necrosis and abscesses. PPD (%) for sonographic findings was 4 for thick wall and/or septae and 24 for solid component. The p value for these two sonographic features was 0.036. PPD (%) for mammographic findings was 27 for mass, and 33 for the combination of mass and microcalcification. The p value for mammographic features was calculated to be 0.133. According to our study, even though the likelihood of malignancy is relatively higher in complex cysts with solid components compared to other complex cysts, no specific finding has been found that would indicate malignancy in complex cysts. Therefore, complex cysts that have a potential of malignancy deserve biopsy