II. Epidemiology
- Breast cysts are most common in ages 35 to 50 years
III. Indications
- Palpable Breast Mass which appears cystic (esp. suspected simple Breast cyst)
IV. Technique
- Use skin marker to mark center of lesion
- Prepare Breast skin with Betadine or Hibiclens
- Drape Breast
- Immobilize lesion between index and middle finger
- Aspirate lesion 21-25 gauge needle and 5 cc syringe
- Draw back on syringe plunger while inserting
- Withdraw and redirect if no fluid aspirated
- Apply local pressure to aspiration site
- Apply Bacitracin and bandage to entry site
V. Complications
- Pneuomothorax
- Prevent by positioning lesion over a rib
-
Hematoma
- Prevent by applying local pressure after aspiration
VI. Efficacy
- Breast FNA has lower diagnostic accuracy than Breast core biopsy
VII. Precautions: Safety
- FNA does not affect MammographySpecificity
- However mammographer should be aware of aspiration
- Aspiration does not increase cancer risk
VIII. Interpretation
- No fluid (failed aspiration)
- Consider breast Ultrasound to better localize
- Refer solid lesions for Breast biopsy
- Bloody Fluid Aspirate
- Do NOT drain cyst (discontinue aspiration!)
- Send fluid for Cytology
- Complete Breast imaging and refer to Surgery for core needle biopsy
- Non-bloody fluid aspirate
- Drain cyst completely
- Discard aspirate fluid
- Reexamine after draining cyst
- Refer to surgery if mass still present
- Repeat Breast Exam in 4-6 weeks (and consider breast Ultrasound)
IX. References
- Smith in Ryan (1999) Kistner's Gynecology, p. 197
- Lucas (2003) Am Fam Physician 68:1983-9 [PubMed]
- Marchant (2002) Obstet Gynecol Clin North Am 29:1-20 [PubMed]