FIBROCYSTIC BREAST CHANGES
A 30-year-old woman experiences bilateral breast enlargement and
tenderness, which fluctuates with her menstrual cycle. On physical
examination the breast feels lumpy, and the patient indicates a sensitive area
with a discrete 1.5 cm nodule, which she says is consistently painful. A
fine-needle aspiration is performed, and clear fluid is withdrawn. Clinically
the cysts resolved.Diagnosis. Cyclic premenstrual mastalgia is often associated with fibrocystic
changes of the breast, a condition that is no longer considered a disease but a
heterogeneous group of disorders. Breast discomfort may be accompanied by a
palpable mass. Fine-needle aspiration can easily distinguish whether a mass is
solid or cystic. The procedure requires no special skill other than stabilizing the
mass so that needle aspiration can be done with precision. The goal of cyst
aspiration is complete drainage of the cyst with collapse of the cyst wall.
Management.
Mass disappears. If the cyst fluid is clear, it may be discarded. If the cyst
fluid is grossly bloody, it should be sent for cytologic examination to rule out
the possibility of intracystic carcinoma. After aspiration, the affected area
must be palpated to determine whether there is a residual mass. If there is no
residual mass, the patient may be reexamined in 4–6 weeks for the
reaccumulation of fluid. If fluid reaccumulates, it may be aspirated again.
Mass persists. A mass that persists requires further workup. A persistent
accumulation is managed by mammography and excision. Because changes