Please help: I had a FNA biopsy with no results

Migz1233

Hi Everyone. I hope someone here can help me. I know I can't get a diagnosis here but would like maybe if someone is going through what I am? I basically had a tiny lump on my areola for about ten years. It started off 2mm.. now it's 4mm and I can actually see it. Specially if I pull my skin up. Very visible.

I was told it was an epidural cyst at the doc appointment but she did an FNA where she struggled to get samples... and it came back negative and my lump never collapsed (like cysts are ment to)... now my doctor is saying I must see a surgeon!!!

What would you guys do???

My biopsy does not diagnose what I have and the doctor is "concerned" and says I have "inflammatory change".

I don't want an operation if it's just benign.

But at the same time she is recommending I chop whatever this little hard rock is out and she has no idea what I have.

LivinLife

Welcome Migz! I can hear your anxiety and powerlessness about where you are now! It seems like a reasonable and good idea to meet with a surgeon. That will help determine indeed what is going on. The biopsy was unable to provide enough, sounds like any, information. Have you scheduled with a surgeon yet or know who you want to see? I don't know that it matters though I'm wondering what kind of doc did the FNA?

Talk with a surgeon, make sure you are comfortable with that person, get their recommendations. If you are comfortable and trust them you will likely have faith in what they recommend as well. This is a very scary time when you do not know what is going on and do not have a plan.

MinusTwo

Migz - where are you located? If the biopsy is "negative", there's no diagnosis. What kind of doc is this? Since the doc is concerned and you're not sure, I'd make an appointment for a second opinion with a breast specialist.

MelissaDallas

So, tiny lumps on your areola are commonly (and frequently) Montgomery gland cysts, which aren’t what you are thinking of as a “watery” cyst, but more like a cheesy pimple type “zit” cyst. Like cystic acne. A fine needle biopsy won’t “draw up” anything from it because the material is too firm and solid. I personally would check in with a dermatologist. Fine needle aspirations are a sub par diagnostic tool for all but the most superficial and obvious fluid filled things. More often than not they yield insufficient material to be diagnostic of anything

exbrnxgrl

I agree that FNA is not a great dx tool. I also agree that, like most in your situation, the unanswered questions are anxiety provoking.

The words surgery and operation can be scary. You may simply need a biopsy of the area in question. When you see the surgeon, breast specialist or whoever is part of your next step, ask about what they are recommending and why. I had a stereotactic and ultrasound guided biopsies on the same day. I wouldn’t really consider them operations/surgeries at all. There is such a thing as a surgical biopsy, essentially a lumpectomy, but since you don’t yet know what is being proposed try not to get ahead of yourself. Regardless, breast cancer is generally not considered an emergency. I know you want answers quickly but be prepared to do a bit of waiting, especially with Covid19, and rest assured that this is unlikely to effect your situation even if it turns out to be cancer.
i wish you all the best

Migz1233

Hi guys thanks for all the feedback! I went to a professional Breast and bone density clinic. I always thought it was just a Montgomery gland that was blocked or maybe an ingrown hair or something like that. But since I have had it for so long and its grown a bit, have no pain at all (only a bit after the FNA) and it is rock solid, my regular Dr recommended I go to a Brest clinic. They are now closed over December and only reopen after January 11th. The only thing the FNA managed to get was some blood, some scattered duct cells and a few other scattered cells. The ultrasound, according to the Clinic they said it was not attached to my nipple or my breast so I'm rather stumped. What could form a random rock hard painless lump. What is more confusing is the breast specialist was so confident that I had an epidermoid cyst.. but then my FNA report came back, "no evidence of a cyst". And now they want to send me straight to a surgeon. I tried searching all over the internet but cant seem to find anything matching what the clinic told me and my FNA. Surly ultrasound or an FNA can detect if its just a little Montgomery issue? I always assumed a FNA could actually give us a diagnosis. Now I feel like it was a complete waste of time and anxiety. The words surgery and operation are definitely scary! And I am more concerned over creating more damage through surgery than just leaving my little lump alone. I was kind of hoping someone here had something similar to me so id know roughly what to expect :-) Exbrnxgrl , how did they do the ultrasound guided biopsies? Does a surgeon do this or a breast clinic? They used ultrasound to do my FNA. Ill definitely take your advice and not go for a lumpectomy without a diagnosis first. I'm just getting anxious since the DR changed from being calm saying its just a tiny cyst and nothing to worry about to now being "concerned" and wants to book me with a surgeon. She was a very sweet lady. As for Covid it really does make it difficult to book appointments and get things done.

Beesie

"And now they want to send me straight to a surgeon" That doesn't necessarily mean that surgery is required. It just means that the results weren't clear so it's suggested that you see an expert. A breast surgeon is the expert on what to do when something abnormal shows up in the breast. The surgeon might suggest watching, he might suggest additional imaging, he might suggest a core needle biopsy - I expect that an excisional biopsy (a surgical biopsy) would be the last option he would consider. Usually other diagnostic options are used first before any suggestion of surgery.

"I always assumed a FNA could actually give us a diagnosis.". No, as the others have side, a FNA is not good for biopsies. A FNA is usually used for cyst aspirations. But if the needle goes in and it hits something that clearly isn't a cyst (cysts are fluid-filled), then usually you have to move to plan B because the FNA won't be much good. So there's nothing much unusual about your situation in this regard.

Right now you are jumping to a lot of conclusions just based on the fact that it's been suggested that you see a surgeon. Think of it instead as seeing a breast specialist (who happens to be a surgeon). Talk to the breast specialist and see what the recommendation is before you assume what will happen next. Unfortunately none of us can tell you what the breast surgeon will suggest because every situation is different.

exbrnxgrl

migz1233,

It’s been over 9 years since my biopsies so please excuse me if my memory is not perfect. I belong to an all inclusive HMO. Everything from hospitals to labs, doctors, pharmacies are part of the HMO, often on a large central campus. I have no idea who performed the biopsies beyond the fact that she was a doctor on staff. As with the stereotactic biopsy, local anesthesia was used to numb the area, tumor was located via ultrasound and biopsied. It was all easier than I imagined.

Although it’s easier said than done, try not to get ahead of yourself. Take care.