Cystic Breast Disease: What to Do When It's Not So Cystic.

This article focuses on the imaging evaluation and management of cystic breast masses, which are common findings in breast radiology and can range from benign to malignant. It reviews key sonographic, mammographic, contrast-enhanced mammography (CEM), and MRI features that differentiate simple cysts, complicated cysts, clustered microcysts, inflamed cysts, oil cysts, and complex cystic and solid masses, emphasizing appropriate Breast Imaging Reporting and Data System (BI-RADS) categorization and follow-up recommendations. The article highlights that while simple and complicated cysts are generally benign (BI-RADS 2), complex cystic and solid masses warrant biopsy due to a higher malignancy risk. It also discusses the importance of multimodality correlation, clinical history, and careful imaging technique to avoid misclassification, particularly in distinguishing benign cysts from malignancies such as triple-negative breast cancer.