الفهرس 
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Abstract
Cystic breast disease has been recognized as the most frequent female benign breast lesion. The prevalence has been estimated to be between 50% and 90%. It most commonly appears during the third decade of life, reaches its greatest frequency during the fourth decade, and sharply diminishes after menopause. The incidence of complex cystic breast lesions in breast US examination is 5%.
Complex cystic breast lesions are classified into three types: Type I are cystic masses with thick walls, thick internal septa (equal or more than 0.5 mm), or both, type II are cystic lesions with intracystic masses and type III are predominantly solid masses with eccentric cystic foci. This is the classification we used in this study. Biopsy of these lesions is recommended.
Breast ultrasound is most often used to evaluate breast problems that are found during a mammogram or physical exam, and to guide a needle biopsy of suspicious mass and axillary lymph nodes.
This study aimed to analyze the features of complex cystic breast lesions at ultrasonography and to determine its appropriate BIRADS categories.
This study was conducted on twenty seven female patients where complex cystic breast lesions were found. Inclusion criteria were a lesion diagnosed to be a complex cyst by US examination: complex cysts features are determined according to criterion of Berg et al and the exclusion Criteria were any previous history of breast surgery, US findings of a simple cyst, clustered microcysts or a complicated cyst and any biopsy contraindications.
All the studied patients were subjected to full thorough history taking, imaging studies which included ultrasonography of breasts, color Doppler examination and ultrasound guided fine-needle aspiration biopsy and/or ultrasound guided core-needle biopsy and histopathological examination of the biopsied tissues.
The age of the included patients ranged from 21 to 51 years old and the majority were in their fourth and fifth decades, 14 patients (51.9%) gave a familial history of breast cancer.
We categorized the complex cysts found into three types, we found 12 cases to have a type I complex cystic lesions and they were assigned as BIRADS 4a and 4b and histopathological assessment of the biopsied tissues revealed a benign behavior of all the cases.
We found six Type II complex cystic lesions and they were assigned as BIRADS 4b and 4c category and histopathological assessment revealed both benign and malignant natures divided equally amongst the six cases.
The remaining nine cases were assigned as Type III complex cystic lesion and categorized as BIRADS 4c and the histopathological analysis revealed both benign and malignant features but the majority were malignant with a 55.6%.
We advise that the described Type I complex cystic lesions be assigned as BIRADS 3 category since 100 % of the cases were found to be benign by histopathological assessment, and that Type II and III be assigned as BIRADS 4 category since half of type II and more than half of type III complex cysts were found to be malignant so the existence of such lesions should be deemed suspicious and hence should be biopsied