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Although many of these lesions can be dismissed as benign simple cysts, requiring intervention only for symptomatic relief, complex cystic and solid masses require biopsy. Perhaps the most challenging are complicated cysts, that is, cysts with internal debris. When the debris is mobile or a fluid-debris level is seen, complicated cysts can be dismissed as benign. When the debris is homogeneous and hypoechoic, it is often difficult to distinguish a complicated cyst from a solid mass. As an isolated finding, homogeneous complicated cysts can be classified as probably benign, BI-RADS 3, with intervention only considered if there is interval development or enlargement, if abscess is suspected, or if suspicious features develop.

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