Fine needle aspiration today~Birads 4/5
This started with left breast issues and they found a 6mm suspicious area in my right breast after a bilateral MRI. Went to have ultrasound today and given birads 4/5, wanting me to come back for FNA, I told the radiologist it was a 2 hour drive for me and within 15 minutes they had me in a room to do the FNA. I have extremely dense breasts and even after lidocaine I still felt some pain with the pressure, they apologized because my breast tissue is so dense the needle bent and they had to start over. I was okay with the discomfort ,then all of the sudden I felt extreme pain and yelled out, the radiologist said she was right at the cyst and was trying to get through the cyst wall, tears flowing I allowed her to continue until I could no longer stand the pain and begged her to please stop. Thankfully, she was able to get some fluid out for pathology. Noticed after I got home that there are 5 puncture marks on my breast. WOW!!! So painful!!! Now...more waiting for results.
Comments
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Lulu I admit I am a bit confused.
It sounds like you have a cyst based on then doing a FNA and getting some fluid for pathology.
Yet you have a BIRAD4/5?…..
Cysts are rarely cancerous. And FNA aren't the best way of getting a sample of a tissue sample. Do you have the actual radiological report of both the US and the MRI?
It would help to understand why a cyst was giving such a high BIRAD # if you have the reports.
Im guessing that your pain and state of mind may have you confused as to what was said and why?
Hang in there!! It's very normal to be scared and anxious!
(edited)
Lulu, I went back and read your other posts.
Sounds like more of a BIRAD4 from what you have posted so not sure why you were told a BIRAD4/5…There is nothing screaming a BIRAD5 from what you have posted.
From what you posted about your MRI, sounds like because of the blow flow they just want to be sure of that 6mm area (and from what you have written, it's a cyst. Rarely cancerous)
Let us know how it goes. Do you know when you get your results?
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Hi Marie...I am sure of the Birads score the FNA was given. I am looking at my paper as I type, the 4/5 is one score for them. She said that they assumed this was a cyst and wanted to try an FNA to see if they could aspirate anything. But she also said the edges were irregular and it looked like it had debris. When the tech was doing the ultrasound before the FNA was brought up, earlier in my appt. I watched the screen, saw that the area in question lit up with what I'm assuming was blood flow. One thing I noticed is the is the difference between the other cysts throughout my breast and I was showed on the computer and this "area" looked very different, this looked nothing like the other round, fluid filled cysts. Another thing is I doubt I will ever allow them to try to "navigate" through my dense tissue for another FNA any time soon...it was like "tug of war" with a needle and my boob. As for getting any reports, the tests were done back to back, so I didn't get any...nor do I know how long it will take to get a pathology report. At the end of the procedure I was in a bit of a "frenzy" so I don't even know what they retrieved form this area. Kinda confused myself...
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Hi there.. I had fine needle aspirations done last spring..since my breast dr found lumps in my good breast.. i did have DCIS in my other breast 2 yr ago..with mastectomy..all is OK with that.. But when I had the mammo it showed possible cysts..had fine need asp..and the person> Dr that did it said there were 2 cysts very close to each other..If she could get fluid out..would be good IF she couldnt then I would need a core biopsy..lucky for me..she got fluid out..told me it was fine..and she didnt even need to sent it to toxocology.. she just threw it away.. I have never heard of Birads 4/5 what is that about?
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Hi ladies! The only thing I can add to this right now is that the area they wanted to do the FNA on, they considered suspicious and abnormal. They wanted to TRY doing an FNA because they were assuming it may be a cyst. Once they were in my breast, bent one needle, they wanted to just try to get into this area to see if anything could be aspirated. With the power she had to put into trying to get the needle into this "cyst", I'm thinking it is more of a mass (just a guess) but being the one laying on the table and given what it took to get it (a lot of pushing power). Whether she retrieved fluid or tissue, or a bit of both, it was sent to pathology. They were very apologetic when the test was over, so maybe they realized that it wasn't the best way to go at that point, either way I am hoping for answers. Would it be wrong to ask for a core needle biopsy?
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Lulu, your thread has confused me from the beginning. I thought all Briads 4, not to mention 5, warranted core needle biopsies. Of course my knowledge base is limited, but that was my assumption. Anyway, I definitely think you are correct to ask for a core needle biopsy, unless the FNA comes back completely B9.
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Wow...I'm starting to feel like I need to be on the defensive when I thought coming here was supposed to be for support. I don't know what Birads score warrants what particular testing. It is kind of a panicky time and apparently from the different threads I've read, each individual is different. The docs and radiologists don't always get it right, they (from what I've read) often misdiagnose or have to have additional tests. I've never been in this situation and don't claim to be an expert. I got on the table to do the requested test and it SUCKED!! Why did they do FNA along with that score? I have no idea. BUT...I'm trying to make sense of things myself. Also, I was told that my insurance covered the FNA, maybe with the insurance there are "steps" to be taken to get other testing covered. I have also read that FNA is very accurate testing for Birads 4 or 5, with breast masses or otherwise. Like I said this is a very confusing time for me and maybe I assumed wrong in hoping for support on this site.
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Hi Lulu,
No reason to be defensive sweetie
We know how scary it is.It's just some of the information you have posted about your experience is confusing for those of us who have experience with all of this. Just trying to sort out the confusing information is all
Did they tell you when you would get your results?
I think it would be wise, since you do have dense breasts, to call and ask them for a copy of the US report, and when pathology comes in, a copy of that report as well …
This way, for future use, you will be able to compare.
Here is a link to the main area of BCO that you may find helpful in unraveling the confusion…
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lulu, please don't feel defensive. Your situation is quite unusual and I think that's why it's got people confused.
I've had lots of cysts of the years. Normally a cyst at most warrants a BIRADs 3, which means that it can either be watched for stability (a 6 month follow-up), or if the cyst is palpable (able to be located by hand), a fine needle aspiration might be done. Simple cysts, which are perfectly round or oval with even, thin walls, are almost always benign. All other cysts are called "complex cysts" and these overall have something like a 0.3% rate of malignancy. Most complex cysts are cysts that are relatively close in appearance to being simple cysts, but the shape might not be perfectly round or oval, or the walls might not be completely even all around, or there might a bit of floating debris in the cyst, etc.. None of these types of complex cysts warrant any concerns.
There are however two particular types of complex cysts that are more concerning. The first type has a cyst wall that is very thick and/or includes a significant proportion of solid nodules as well as fluid (fluid being what defines it as being a cyst). The second type is a mass that is primarily solid but that includes some cystic foci. These types of cysts are very rare but if one does show up, the malignancy risk certainly would warrant a BIRADs 4 and a biopsy.
With this type of cyst, because it's the solid component that is raising the concern and because fine needles aren't usually used for biopsies of solid masses, the expectation is that a core needle biopsy would be done rather than a fine needle aspiration. However in reading through the following article about cysts, it appears that FNAs were in fact done on many of these concerning types of cysts:
Sonographic Differentiation of Benign and Malignant Cystic Lesions of the Breast
I think the reason most of us here find your situation to be so unusual is because these types of cysts are so rare - not many women come to this board with these types of BIRADs 4 worrisome cysts - and in the few times that I can recall where it's happened, a core needle biopsy or excisional (surgical) biopsy has been done. That's why you're getting the questions. But from the article, it appears that at least starting with a FNA is what's often done even when a cyst includes a significant solid component.
So sorry that you had to go through this, and good luck with the results!
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Hi Lulu - sometimes things sound differently online than what people mean them to. You are absolutely right, this is a place to seek support and understanding for what you are going through. Like you, I have very dense breasts - the ultrasound tech bent five needles doing fine needle aspiration. One thing I didn't know prior to my diagnosis is that dense breasts present problems because things don't show up well on imaging (I had a 9cm tumor that could not be seen with a mammogram). Cysts are usually round and can be differentiated easily but there are also things called 'complex cysts' (I think that's the name) - they look like cysts but also have fibrous stuff running through them & they can sometimes be cancerous. I think part of what is confusing people here is that usually the BIRADS score is either a 4 or a 5 (they ALSO however sometimes assign a score for breast density). Here is a site that has some info on what the scores mean: http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/mammogramsandotherbreastimagingprocedures/mammograms-and-other-breast-imaging-procedures-mammo-report
A BIRADS 4 score is quite different than a BIRADS 5 score, about 80% of people who have biopsies after a score of 4 have benign results - whereas BIRADS 5 are almost always cancer .
It's really hard to know what is going on when you are the person having the procedure - it sounds to me (and this is a guess) that you have one of these complex looking cysts & that they were getting both fluid and tissue. The biggest question right now is when the results from this path report are supposed to come back. It is really stressful waiting for the results. Sometimes it's a good idea to call them (especially around this time of the year). It also sounds like they actually did end up getting a sample - sorry that you had to go through so much pain for that sample to be gotten (they really don't know until they get in there how difficult or not difficult it is going to be - my tech was really surprised when the needles kept bending).
While you're waiting for the path results, know that even if they do find cancer, there are many different types of breast cancer (not everybody needs to have chemo or even a mastectomy). Also, while you are waiting, try to treat yourself well. Go out to lunch with friends, watch movies, - whatever things you like to do. Waiting is awful & having a bad biopsy experience without a good explanation of why they're doing what they are doing makes it even harder. Many hugs.
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Lulu,
Any results yet? Did they tell you when you should hear?
There have been a couple of other ladies who also were given the unusual BIRAD 4/5 rating. Im guessing it's the equivalent of a BIRAD 4C
Hope you are ok...
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Lulu,
Any results yet? thinking about you….
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Hi, Ladies...first of all let me tell you the FNA results were benign (GREAT news!!) I called the office and was told this info by the nurse and she said that Dr. Teal is out the rest of the week and will be back on Monday, so "final call" has to be approved by her and by that the nurse said if the previous testing (MRI and US) don't correlate with the benign result of the FNA then the decision will be hers as to whether or not more testing like a core needle biopsy would need done. NOW...my question to you is: if you were me with the MRI and US apparently showing something suspicious enough for the Birads score of 4/5 (which I'm hoping I get a call from her and not a nurse because I intend to write down questions over the weekend that I would like answers to since I haven't seen any actual reports from these tests-I live in Pa. and the Breast Care Center is in D.C.) would you be satisfied with the difficulty getting FNA and maybe not the best test for a complex cyst. I just feel as if MY satisfaction would come from adding a core needle biopsy, would it be wrong to ask for one? I am so grateful that the FNA result was benign! Am I being paranoid? Maybe...even so I need some input. Thanks!
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marie...THANK YOU for checking on me!
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Lulu, if it collapsed with the FNA it was pretty clearly a cyst. Wait & see what the doc says, but what about just scheduling a three month recheck if he thinks that is reasonable?
I just went through something very similar. I had a birads 4 that looked like a lymph node or small mass - not cystic - but when they stuck it with the core needle it collapsed, so that was indeed what it was!
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So Glad hear that…It is VERY scary when one doesn't know, and has to wait…
As to your question. Basically it comes to down to this, IMO anyway.
For a cyst or a complex cyst I would feel comfortable with the results of a FNA biopsy. They, cysts and complex cysts are RARELY cancerous.
However if the MRI and US results, show something other than a cyst/complex cyst, I would go for a core needle biopsy if the doctor feels that there is an area of concern that has nothing to do the complex cyst. Core needle biopsy get actual tissue samples, FNA gets more liquid.
Does that make sense?
(Also what I would do, is get actual copies of the radiologist's mammo, US, MRI reports. Im still not clear as to why a complex cyst was given a BIRAD 4/5 unless there was more on the imaging of the surrounding area of the cyst. (That is only based on my understanding of the research I have done in the past few years)
Im not a fan of the BIRAD 4/5 score (VERY confusing) unless the poster who mentioned in her post that her mammo had one score and her US another.
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Melissa...it did not collapse, the radiologist Dr. Brem had to put a good bit of force into getting through the "thick wall" as she described it and I felt everything when they were trying to "aspirate" it was VERY painful!
Marie...the score was given from the US...my most recent mammogram (October) was not done at their facility, though I did take all of my mammo and US imaging to them and they copied it into their system. I will be sure to ask the doc when I talk with her what findings warranted that score.
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Yay LULU !!!! YAY benign! I've been checking in all day hoping for that result.
I wouldn't be worried about getting a core biopsy - ask for a follow-up as Mellisa suggested (biopsies are intrusive - better to not have them if you don't need them).
Please do let us know about what your doc says about the 4/5 score - it's been showing up fairly frequently & it'd be helpful if we were able to tell people with more certainty what it means.
YAY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Please go out and celebrate.
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SInce it did not collapse, when you talk to the Dr ask him that since you were given a BIRAD 4/5 wouldn't it be advisable for a core needle biopsy…
I am only saying this based on my understanding over the past few years, and what I would do. I think my mind would need that kind of peace of mind testing….
But that is me…
Melissa did bring up an option to consider if you feel comfortable with it. Maybe a follow up in 3 months? (that works for some women's peace of mind; for others it doesn't. That is something only you can answer for yourself…)
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(Lulu, I did a bit of research on FNA and false-negatives. The following comes for a 2007 study…I bolded a part in the *conclusion* section which seems to agree with what you are told. If the pathology and the radiological imaging agree, FNA is reliable. HOpe this helps with your decision making process )
http://www.ncbi.nlm.nih.gov/pubmed/17986804
Ishikawa T, Hamaguchi Y, Tanabe M, Momiyama N, Chishima T, Nakatani Y, Nozawa A, Sasaki T, Kitamura H, Shimada H.
Author information
Abstract
BACKGROUND:
Fine-needle aspiration cytology (FNA) is less traumatic and technically easy to apply to small breast tumors.
METHODS:
A total of 382 cases of palpable breast lesions that had undergone fine needle aspiration and histopathologic diagnosis were reviewed with an emphasis on the rate of false positive diagnoses in benign breast lesions.
RESULTS:
A diagnosis of " malignant " was made in 98 of the 382 specimens (25.6%). The predictive value for malignancy was 97.9%. The sensitivity, specificity, and accuracy of FNA were 86.3%, 98.2%, and 93.2%, respectively, when the " suspicious " group was considered positive for malignancy. The histologic subtypes of the 4 false-positive cases were epithelial proliferative lesions, ductal or lobular hyperplasia. None of these 4 cases were definitely diagnosed as " malignant " by radiological studies. Four false-negative cases by FNA were suspicious for malignancy radiologically. There was no specific pathological subtype associated with false-negative status on FNA in this study.
CONCLUSION:
Palpable breast tumors can be definitively diagnosed based on a combination of physical examination, radiological studies and FNA, when the radiological studies concur with the diagnosis by FNA.
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marie...I think that is where I am right now...that with the score and difficulty with FNA, that a core needle biopsy would put my mind at ease. And to me, personally, MY peace of mind counts too, right?! Regardless of the results of the biopsy, they already want me back in 6 months for an MRI. My doctor and radiologist are both women...I looked them both up and Teal-doc did an interview on Good Morning America and Brem-radiologist was on Dr. Oz Show. So, I will ask my questions and trust their experience. THANKS ziggypop! I know I must sound as if I'm not grateful that the FNA results are benign, that is NOT the case...I'm extremely thankful and pray that IF there are any other tests done that the results will also be benign!!
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Lulu... When I was 35 and could feel a lump, the doctor thought it was a cyst and tried to aspirate, but it was solid, so I went on to imaging (hadn't had any yet) and it didn't even show up. I had it surgically removed and it was ADH and a benign mass. Fast forward 13 years and I again had a lump. My surgeon (looking at an US) said it was cancer, but would do a fine needle biopsy for confirmation. That came back inconclusive. And yes, it was cancer. And the MRI was the best imaging for that. Some other suspicious stuff showed up on my MRI and so I had an MRI guided biopsy, turned out to be a pappilloma (benign but shouldn't remain inside me)... My point is, I would have a better test, core needle biopsy or something. FNB are not great.
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Thank you bdavis for the info. Mine isn't a palpable lump, I went for left breast problems (nipple discharge, large lump since has formed into my nipple with a lot of pain) but since I have extremely dense breasts the doc at the new Breast Care Center wanted a bilateral MRI... just to check. The suspicious area found on the right just happened to be found because she ordered that MRI. My usual tenderness in the right breast but otherwise no symptoms. Again thank you for sharing your story... It makes me realize that no one woman is the same as the other with symptoms, testing, results and so on.
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Marie... Thank you for looking that info up for me. My area isn't palpable. The assistant radiologist that started the FNA (the head radiologist took over due to the difficulty doing the test) was concerned when she was looking for the area with US because it is in the breast about 2 cm. from the nipple (behind it if you're laying down) she said she wasn't sure what to to because she didn't want to go through my nipple...I asked if you give me lidocaine I'll be numb anyway... she said it would be very painful for me to even have them numb the nipple due to how sensitive it is... so they navigated through the dense tissue.
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Hi Ladies! Back with an update...the doctor called me today. So first she said everything came back completely benign, I'm very happy with that news! IF it would have been a cyst or a complex cyst but I asked her, "so, it was a complex cyst?" No, she told me it was an atypical mass. Is FNA really a reliable test for that because somehow I'm not feeling at ease?! I also asked her about the Birads score of 4/5...putting them together as one. She said that is for insurance purposes...so biopsies are covered. She is sending me my cytology report. So, wanting to discuss with her the original reason for going to see her in the first place was my left breast...I tried to talk, she pretty much dismissed me and my concerns, told me to take evening primrose oil. Our whole conversation lasted about 3 minutes, I was being brushed off and told to come back in 6 months for another MRI...I get the whole "wait and watch" but I do not like to feel as if I am a bother or just a number. I am angry, I've cried.
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Well.. Personally I am not a fan of the FNB, and I don't trust it from my own experience. If you felt she didn't give you the proper amount of time, go see someone else.
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Lulu, one important thing that i've learned from these forums over the past few years is that you have to be your own advocate. Your peace of mind is very important. If you're telling yourself that you'd prefer to have a core biopsy, then go elsewhere and get it. Wishing you the best.
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...I too am not a fan of FNB...
And with "atypical cells"....well even more so...
But that is me...
And yes, I would be asking for a second opinon and a core needle biopsy...
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Yes, I agree and should add, that any atypical mass should probably be removed. I had an atypical mass at 35, had it removed and still got cancer 13 years later. Did she say ADH? Atypical ductal hyperplasia? Because many doctors will not only remove the abnormal mass, but put patients on tamoxifen to prevent cancer. ADH is like a gateway to cancer. Not necessarily, but it raises one's risk about 4-5x. Either way, benign and benign with abnormal cells are not equivalent to me.
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So basically this doctor blew you off- maybe she had an appearance scheduled on GMA
. Get the cytology report and the radiographic images tell them thanks but no thanks and find someone who has time to talk with you, reassure you and allay your concerns. There are so many great and compassionate docs out there- just find yours.
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Hello Ladies!
Let me first say "thank you" for your encouraging words! I am feeling so many different emotions right now anger, frustration, confusion...and "let down". I had done research on George Washington University Hospital Breast Care Center and though it's about 2 hours (one way) from where I live I was okay with that because I had seen good reviews and one of the most important factors was that they have the most up-to-date imaging for women with dense breasts (like ABUS ultrasound). I will wait for the cytology report and intend to call the radiology department today and request a copy of reports from my MRI and US. I can't tell you anything more than she said it was an atypical mass until I get the report(s) on my right breast. Being "dismissed" completely about my left breast is beyond frustrating. She didn't want to discuss it because the MRI findings were benign, which is great but my problems with it have gotten worse since October when the spontaneous discharge started. If she would have given me a chance to talk (instead of cutting me off and telling me to take primrose oil) I was trying to tell her that the pain wakes from up from sleep, there are shooting, stabbing pains that can "stop me in my tracks", I have pain that seems to wrap around my shoulder, stinging in my nipple, after the discharge started (maybe sometime in Nov.) I was doing a BSE and noticed at the outer edge of my breast there were 2 pea-sized lumps (with no pain) that since have started to kinda grow together like there is tissue connecting them, my breast feels heavy, with or without a bra- not much of a comfort zone either way there, the area under my collarbone is sore and sometimes painful, the biggest problem for me is the dense/fibrocystic/lump/mass has increased in size and is putting pressure into my nipple (area measures about 2 inches x 3 inches from the outside) that makes my nipple feel like it may blow right off of my breast at times and if my arm or anything brushes it, it's very sensitive and painful. So yes, I am very well aware that it was found to be benign and fibrocystic BUT when it becomes so much of an inconvenience and painful part of everyday...well I just wanted to be heard and discuss the possibility of removing it. Sorry, just needed to rant. Thanks for listening!
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