Aspiration of Breast Cyst

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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Chapter 228 Aspiration of Breast Cyst

DESCRIPTION

Fluid is removed from breast cysts via aspiration. This may be performed for both diagnosis and therapy.

INDICATIONS

Palpable breast mass that is credibly thought to be cystic in nature.

CONTRAINDICATIONS

Local skin infection, known or suspected allergy to agents used (e.g., latex, iodine).

REQUIRED EQUIPMENT

• Skin preparation materials (alcohol, iodine- or hexachlorophene-based antibacterial solution [e.g., Betadine, Hibiclens])

• Self-adhesive bandage

• 10-mL disposable syringe

• 22- to 25-gauge needle

TECHNIQUE

In women older than age 35, mammography prior to aspiration should be considered because of the increased incidence of malignancy. Once aspiration has been attempted, mammography should be delayed several weeks because of artifactual changes induced by the manipulation, rendering mammography difficult to interpret.

Following adequate skin preparation, the nondominant hand stabilizes the cystic mass. This is accomplished by using the thumb and fingers to gently pinch the breast tissue below the mass. A 22- to 25-gauge needle (attached to a 10-mL syringe) is inserted into the cyst cavity. A small “pop” or loss of resistance is often felt as the cyst wall is breached. The cyst contents are aspirated by gentle suction from the syringe. Firm pressure applied for 5 to 10 minutes will reduce the risk of hematoma formation. No dressing or special breast care is required, although a self-adhesive bandage may be used.

Fluid aspirated from patients with fibrocystic changes will customarily be straw colored. Fluid that is dark brown or green occurs in cysts that have been present for a long time but is equally innocuous. Because of high false-positive (up to 6%) and even higher false-negative rates (2% to 22%), cytologic evaluation of the fluid obtained is of little value.

COMPLICATIONS

Hematoma, infection (rare).

FOLLOW-UP

If the cyst disappears completely and does not re-form by a 1-month follow-up examination, no further therapy is required. If no fluid is obtained, if the cyst re-forms within 2 weeks or must be repeatedly aspirated, or if a mass persists after the aspiration, biopsy should be performed.

CPT CODE(S)

19000 Puncture aspiration of cyst of breast

19001 Each additional cyst

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