Simple breast cysts: should we treat or not?

We read with great interest the article entitled “Effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts” by Ozgen (1), which has been recently published in Diagnostic and Interventional Radiology. However, we would like to address some limitations. First, simple breast cysts do not need any follow-up, as they do not show malignant transformation. Therefore, they do not require any treatment, particularly in asymptomatic patients (2). In this study, minimum lesion volume was reported as 4 mL. Such a small lesion probably does not cause complaint in the patient. Secondly, in cases treated for pain relief, it would be interesting to see how much benefit was obtained, whether the symptoms improved after the treatment, and which symptoms were resolved after the ethanol injection treatment. Thirdly, in this article, the intervention was performed on three asymptomatic patients. The reason for ethanol injection treatment in these patients remains to be elucidated. Furthermore, after the ethanol injection treatment, ultrasonography was performed at one week, one month, three months, and six months for all patients and at 12 months, 18 months, and 24 months for all available patients. However, the follow-up of patients with simple breast cysts with repeated ultrasonography is not a cost-effective management modality, and not acceptable. Although ethanol injection might be used as an alternative for the treatment of recurrent breast cysts (3), selection of patients and duration and frequency of follow-up should be arranged meticulously.