Integrated Ultrasound and Cytological Assessment of Breast Cysts: A Cross-SectionalDiagnostic Study for Predicting Malignancy

Objective: To evaluate the diagnostic performance of an integrated ultrasound and FNAC approach in differentiating benign and malignant breast cystic lesions Study Design: Cross-sectional diagnostic studyPlace and Duration of Study: This study was conducted at the Tertiary Care Hospitals in Mosul, Iraq, from January 2025 to December 2025. Methodology: Women presenting with breast cystic lesions underwent ultrasound and FNAC evaluation. Histopathology served as the reference standard. Logistic regression and ROC curve analysis were performed toassess diagnostic performance. Results: Complex cyst morphology, irregular margins, vascularity, and suspicious FNAC findings were significantly associated with malignancy (p < 0.001). The integrated model demonstrated superior diagnostic accuracy (AUC = 0.93) compared to ultrasound alone (AUC = 0.81). Sensitivity and specificity exceeded 90%. Conclusion: The combined ultrasound–FNAC approach significantly enhances diagnostic accuracy and supports clinical decision-making in breast cyst evaluation.