WORK-UP of ANY Breast Mass

1- Breast clinical examination, is the first step to perform upon a complaint of a palpable breast mass.

2- Ultrasonography: it's done for diagnosis of breast masses in young females less than 40 years old, though you may skip the U/S directly to the FNAB.

3- Mammography(coupled with Biopsy): In females older than 40 years old with;

 -Bloody  discharge/ or the cyst didn't collapse completely after aspiration

 -Inflammatory breast changes/Paget's disease

 -presence of a bloody nipple discharge

 -Recurrent masses at least TWICE within less than 6 weeks after aspiration

 4- Biopsy (fine needle or excisional):

It may be done with or without U/S in young females, or done together with mammography in females that are meeting the above criteria mentioned above, 

it can be both curative and diagnostic and the resultant from aspiration should be sent to cytology.

N.B. if mammography was showing micro-calcifications then most probable the case is benign, however you still should perform core biopsy because in 15% of conditions those micro-calcifications may be an early sign of malignancy.

If a cyst recurs after FNAB ONCE in 6 weeks in a female older than 50 years old, then you would repeat clinical examination and perform a FNAB.

If a cyst didn't collapse completely or occurred twice within less than 6 weeks or released a bloody discharge or there was inflammatory changes suggestive of malignancy, then you should perform a mammography coupled with core (excisional) biopsy.