Solid Masses with Cystic Spaces in Breast Malignancy: A Radiological Indicator of Aggressive Tumor Biology

To determine the prevalence of cystic spaces in malignant breast masses on ultrasound, assess their association with molecular subtypes, and evaluate correlations with pathological markers.

A retrospective cross-sectional study was conducted in a tertiary care center from January 2022 to March 2025 which included 269 female patients with biopsy-proven malignant breast masses. Breast ultrasound was performed before the biopsy to characterize the masses, including the presence of subcentimetric cystic spaces within the solid masses. Chi-square test and unpaired t-test were employed to evaluate the association between cystic spaces within solid masses and molecular subtypes and pathological markers (Ki-67, mitotic score, epidermal growth factor receptor (EGFR). Adjusted analysis was done using multivariate logistic regression.

The cystic spaces within the solid masses showed significant association with molecular subtype (p < 0.001), Ki-67 (p < 0.001), EGFR (p = 0.003) and mitotic count (p < 0.001). There was a strong association between the presence of cystic spaces and triple negative breast cancer (OR = 5.758), which decreased after adjusting for the pathological markers (OR= 2.123) CONCLUSION: Cystic spaces within malignant breast masses could serve as a possible imaging biomarker for aggressive tumor biology, meriting further evaluation for triple negative breast cancer.