Can mammography determine whether a mass is cystic or solid?

• A. Yes
• B. No
• C. Only with contrast
• D. Only if ultrasound is used

Answer: (B)

Mammography cannot reliably determine whether a mass is cystic or solid. It images density and borders in a two-dimensional projection, but it doesn’t reveal the internal composition of a lesion. A cyst can look like a well-defined density on a mammogram, and a solid tumor can have a similar appearance, with tissue overlap and lacking information about contents. Because of this limitation, ultrasound is used to distinguish cystic from solid by assessing internal characteristics: simple cysts are typically anechoic with posterior acoustic enhancement, while solid masses show internal echoes and may have vascularity. If there’s any doubt or the breast is dense, ultrasound becomes the preferred method to characterize the lesion and guide management.