Cysts With Masses and Masses With Cysts: An Imaging Review of Cystic Breast Masses

Prasanti G. Vachhani, MD; Anjuli Shah, MD; Kelly Fabrega-Foster, MD; and Susan Harvey, MD


Appl Radiol. 2017;46:8-18. 

In This Article

Abstract and Introduction


Cystic lesions in the breast commonly present in women aged 30–50 years. They typically appear as circumscribed masses on mammography, but they can be more accurately evaluated on ultrasound.[1–2] Assessment of masses on ultrasound is guided by the Breast Imaging Reporting and Data System (BI-RADS) and evaluation includes shape, margin, orientation, echotexture, posterior acoustic changes and vascularity.[3] Simple, complicated and clustered cysts are typically benign; however, complex cystic masses containing mixed cystic and solid components are indeterminate. Complex breast cysts have thick septations, thick walls, intracystic masses or other solid components. Between 23% and 31% are associated with malignancy; therefore, biopsy is required.[2]

Clinical history often narrows the differential diagnosis; however, ultrasound-guided biopsy may be required for definitive diagnosis. Additionally, solid masses may present with cystic spaces, suggesting a different pathology. Given the variable and challenging imaging appearance, we provide this review of the imaging and differential diagnosis for cystic breast lesions.