Procedure

Breast Cyst Aspiration

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Breast Cyst Aspiration, FNA of Breast, Breast FNA, Fine Needle Aspirate of Breast Lesion

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