This is an
exclusion diagnosis, mostly done based on the clinical presentation after ruling out breast cancer. Nipple fluid aspiration can be used as a classification cyst type method (and to some extent improve breast cancer risk prediction) but is rarely used in practice.
Biopsy or fine-needle aspiration are rarely warranted. Fibrocystic breast disease is primarily diagnosed based on the symptoms, clinical
breast exam and physical exam. During this examination, the doctor looks for unusual breast areas, both visually and manually. Also, the
lymph nodes located in the axilla and lower neck are examined. A complete and accurate
medical history is also helpful in the diagnosing process. If the patient's medical history and physical exam findings are consistent with normal breast changes, no additional tests are needed; otherwise the patient will be asked to return a few weeks later for reassessment. Women may detect lumps in their breasts during self-examination; if this happens it is strongly advised to visit a health professional immediately.
Imaging In order to establish whether the lump is a cyst or not, several imaging tests may be performed, which may include mammography, X-rays, MRIs and ultrasound studies.
Mammography is usually the first imaging test to be ordered when unusual breast changes are found during a clinical breast examination. A diagnostic mammography consists of a series of X-rays that provide clear and specific visualization of areas in the breast.
Ultrasounds and
MRIs are commonly performed in conjunction with mammographies as they produce clear images of the breast that clearly distinguish between solid masses and fluid-filled breast cysts. These can better evaluate
dense breast tissue, especially in young patients under 30.
Biopsy Breast biopsy is a test used to confirm the suspected diagnosis only after imaging tests have already been performed and revealed unusual-looking areas. The procedure consists in removing a sample of breast tissue, which is then studied by a pathologist under a
microscope. The specialist analyzing the tissue sample will be able to conclude if the breast changes are benign or malignant. There are four main types of procedures for breast biopsy that may be performed, including
fine-needle,
core-needle,
stereotactic biopsy and
surgical approach. A fine-needle aspiration biopsy is usually ordered when the doctor is almost certain that the lump is a cyst. This test is generally performed in conjunction with an ultrasound which is helpful in guiding the needle into a small or hard-to-find lump. The procedure consists in inserting a thin needle into the breast tissue while the lump is palpated and seen live under sonographic ultrasound waves. The core-needle biopsy is normally performed under local
anesthesia and in a physician's office. The needle used in this procedure is slightly larger than the one used in a fine-needle biopsy because the procedure is intended to remove a small cylinder of tissue that will be sent to the laboratory for further examination. A newer type of breast biopsy technique is the stereotactic biopsy which relies on a three-dimensional X-ray to guide the needle of non-palpable mass. The biopsy is performed in a similar manner, by using a needle to remove a tissue sample, but locating the specific area of the breast is done by X-raying the breast from two different angles. Surgical biopsy is performed to remove the entire lump or a part of it. It may be painful and is done under local anesthesia. ==Treatment==