Complicted CYST - suspicious for cancer - BI-RADS category 4

OlgaE69

Biopsy in a few days. Totally stunned. I didn't know that a cyst could even be malignant! I've had them for years and had a large one drained once because it was painful. Now I am 69 and have an enormous extended family I dread telling. In fact I won't unless I have to - if I find out I actually do have cancer.

How long do I have to wait for results of the biopsy? I see so much variation of that answer n Goggle.

It is quite tiny - under a centimeter. No symptoms - found in the routine mammogram. Confirmed in the more detailed mammogram and ultrasound imaging.

djmammo

OlgaE69

There are many types of cysts with very specific features that can indicate whether they are either benign or suspicious.

Can you post the US report?

OlgaE69

Yes. Thank you!

"In the left 2 o'clock position 8 cm from the nipple, there is a 0.5 by 0.5 by 0.5 cm round anechoic avascular mass with slightly indistinct margins which represents a likely sonographic correlate for the new left breast mass identified on screening. There are no additional suspicious cystic or solid masses in the left breast.

There is no pathologic-appearing adenopathy within the imaged portions of the left axilla.

IMPRESSION:

1. New left breast mass identified on screening corresponds to a round solitary subcentimeter complicated cyst. Precautionary ultrasound-guided aspiration/biopsy is recommended to exclude malignancy.

2. No pathalogic-appearing adenopathy within the imaged portions of the left axilla.

BI-RADS Category 4. Suspicious.

RECOMMENDATION: Ultrasound-guided cyst aspiration/biopsy of the left breast."

* I was told that there is left breast asymmetry and on the mammogram portion of the report it is noted "The breast parenchyma is heterogeneously dense."

I have no family history of breast cancer. I am 69 years old and have had fibrocystic breasts for many years. Had one large painful one drained about 10? years ago.

My mother took DES while pregnant with me in 1950 and I kept the letter I received about that in 1975 from Baylor College of Medicine. Dr. Herman Gardner. At that time i was told that there might be "minor changes in the genital tract." I was examined at that time and everything was fine. I was told that cervical cancer would be the only significant risk.

When I was 9 or 10 one nipple (don't recall which one) became swollen and red and there was a knot beneath it. Surgeon decided that it was an estrogen issue and that there was no serious problem. Eventually the other one caught up. Never had any further problem with my breasts.

Thank you for your interest.

djmammo

OlgaE69

There is a difference between simple, complicated, and complex cysts. Simple cysts are benign, most complicated cysts are benign, complex cysts are suspicious.

What is described here is a "round anechoic avascular mass" which is the description of a simple cyst but with the addition of the "slightly indistinct margin" comment, they decided to call it complicated as a precaution.

Either way a cyst aspiration is usually a quick and simple procedure as breast procedures go. Let us know how it goes.

OlgaE69

I had the aspiration done this morning and blood came, so immediately she did a biopsy. Four punches and she inserted a clip.The cyst (or whatever it was) was so tiny - less than a centimeter - and after that they couldn't see it anymore. I think it was obliterated.

The three ladies with me were very kind but I could tell there was concern.

I think I am a bit stunned because I was convinced that I would only have the aspiration and nothing else.

Now I have to wait even longer. I had a list of questions in the event that I had a biopsy in my purse in the locker but completely forgot all about it.

OlgaE69

Just want to know what it means if blood comes in the aspiration of a cyst.

Where does the blood come from in a cyst?

Why is that yet another reason for suspicion?

Can't find the answers to those questions anywhere...

djmammo

OlgaE69

Two basic reasons for seeing blood on cyst aspiration

1) Blood inside a cyst raises the possibility that it contains solid elements that have a blood supply (a complex cyst, not a complicated cyst) which is suspicious for malignancy. If the cyst is large enough to see that the tip of your needle is clearly within the cyst and you see blood returned in the syringe it would prompt one to switch to a core biopsy.

2) There are lots of blood vessels in the breast and they cannot always be avoided. If you hit one during an aspiration you may see blood returned in your needle. This is more likely to happen when multiple passes are made through the target area and is basically related to the micro-trauma.

OlgaE69

I truly appreciate your prompt replies! My husband asked, "Well, didn't the aspiration needle have to pass through blood vessels?" I think the doctor said that the blood was very bright red and fresh-looking. She said it could be an injury, but she seemed doubtful. My goodness! The cyst was so tiny I cannot imagine that MUCH blood could have come from it. I did not see that, though.

The cyst pretty much was obliterated after the 4 biopsy punches. She couldn't even see it anymore...but I wonder about something microscopic which might not have not have been pulled into the biopsy needle.

I remain confused about how a cyst which looked so circular - like a bubble- and dark could have contained anything solid. I do recall that the doctor who did the initial mammogram pointed to a lower edge of the cyst which looked sort of gritty or granular to me. Rough-looking I guess.

I know that when I get a phone call maybe as early as Friday I will get the answers I so desire.

This has been a really intense experience since I received the first letter about an "area of concern" regarding the mammogram taken on August 16th. Then the second letter arrived regarding a second mammogram taken on August 28th - recieved on Sept. 9th - "...an abnormality suspicious for cancer and requires biopsy."

I feel pretty calm about it right now for some reason. Prayer helps!

Thank you once again! You do a great service to others!

djmammo

OlgaE69

"My goodness! The cyst was so tiny I cannot imagine that MUCH blood could have come from it."

No one thinks that much blood came out of a tiny cyst. The problem is when that happens you cannot tell if the fluid in the cyst was bloody so you a compelled to do the core to get tissue.

"...but I wonder about something microscopic which might not have not have been pulled into the biopsy needle."

This could be said about all the biopsies ever done.

"I remain confused about how a cyst which looked so circular - like a bubble- and dark could have contained anything solid."

You can find the answer to that concern here.

OlgaE69

Well, I should get the report sometime tomorrow, so I don't think I will order that book suggested in the link. It looks a bit $$$ pricey for me!

I appreciate your information.

OlgaE69

Yesterday I learned that the cyst was not malignant. I went to get copies of the final report this morning and am thankful for all of the information available to me on this website.

My heart goes out to everyone ~ I learned so much and in the future I intend to be more alert.

Special thanks to you, djmammo.

Meow13

Thank goodness.

djmammo

OlgaE69