Complex Cysts
I had a diagnostic mammo and an ultrasound yesterday. They found several simple cysts and two complex cysts. The doctor that came in told me to come back in six months for another ultrasound. Does this sound right to anyone? Six months?
Last year I had an ultrasound because of nipple discharge and everything came back okay. They did find several cysts that once a doctor looked at were deemed 'okay".
But now that they actually found something, I think having to wait six months is pretty long. Shouldn't they at least be doing a needle biopsy? I have to wait until Monday to talk to a doctor, but I started doing some research last night when I got home. I am pretty sure they did not compare last year's ultrasound to this years, so I don't know if there were any changes. Wouldn't that be protocol?
What makes me the most nervous is the fact that my gyne initially told me it was all probably nothing, but that if they see something on the mammo, they will probably want to do an ultrasound. "Don't be too concerned. But if the technician goes to call me or another doctor" then there is something to worry about. So after the mammo, when they wanted to do the ultrasound right away, it was a little worrying, but then when the tech went to get a doctor, I got more than a little concerned. I know this is normal, but again, I can't imagine having to wait six months. From everything I am reading, it sounds like they do FNA right away for complex cysts or the longest they make a woman wait is two months.
Any information would be greatly appreciated.
Thanks!!
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I'd like to hear the answer on this one also. I have two solid cysts that they are wanting to biopsy, but I also have a complex cyst that they are recommending follow up in 6 months. Should I try to convince them to do the complex cyst biopsy at the same time?
Amy_T
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Cysts are very common and almost always harmless. Simple cysts are round with smooth edges; complex cysts may include some debris. According the articles below, 5% of all ultrasounds show complex cysts. Having a 6 month follow-up when a cyst is found is not unusual because cysts are so common and are so rarely serious. As well, in determining the course of action, the characteristics of the cyst would be examined on the ultrasound film to determine the likelihood that it could be anything more than a harmless cyst. If none of the 'concerning' characteristics are present, there is no reason to take any action with a cyst. In all, fewer than 1/2 a percent of all complex cysts are malignant and those cysts show specific characteristics on the ultrasound film.
Having said that, I've had lots of cysts over the years and my doctor always preferred to aspirate them right away. Because cysts are fluid-filled, they don't require a traditional biopsy; a cyst can be aspirated in the doctor's office with a simple needle and syringe. It takes a couple of minutes and it's painless, and then the cyst (and the lump) is gone. As long as the fluid pulled from the cyst isn't bloody, it's not even necessary to send the fluid in for analysis. And, if by chance the needle is inserted and it hits something hard, then the doctor knows that you have something other than a cyst and then more tests and a more traditional biopsy (core needle or excisional) might be necessary. I know that most doctors don't automatically aspirate cysts but if you are uncomfortable waiting 6 months for a follow-up ultrasound, there is no reason why you can't request that your cysts be aspirated.
Amy, what sort of biopsy are you having for your other lumps? Since they are solid, they aren't really cysts - cysts are fluid-filled. But there are types of solid lumps that are also very common and harmless. A fibroadenoma would be the best example - I've had a couple of those too. I would think that at the same time that you are having your biopsy, the radiologist should be able to aspirate your cyst.
Here is some information about breast cysts from: http://www.imaginis.com/breasthealth/ultrasound_images.asp
- Breast Cyst Breast cysts, tiny accumulations of fluid, are the most common cause of benign (non-cancerous) breast lumps in women between age 30 and 50. Simple cysts are typically round or oval and have smooth edges. Complex cysts can be filled with debris and may sometimes require aspiration to confirm that they are indeed benign cysts. Both single and multiple cysts are very common. The exact causes of cysts are not known, but they do tend to change with hormonal variations, either during normal menstrual cycles or from post-menopausal hormone replacement therapy.
- When examining a breast abnormality to determine whether it is a cyst (or multiple cysts), the radiologist will study the quantity, size, and internal characteristics of the abnormality. Cysts do not become cancer or increase the risk of cancer. Most of the time, cysts may be left alone, but sometimes a physician may drain them with a small needle using ultrasound guidance. This procedure is called cyst aspiration.
And here is a detailed article about complex cysts. It explains that about 5% of ultrasounds result in the finding of a complex cyst, that a 6-month follow-up is the most common course of action, and of all complex cysts included in this study, only 1 (0.03%) turned out to be malignant: http://www.ajronline.org/cgi/reprint/173/5/1331.pdf
- Management of Complex Breast Cysts OBJECTIVE. This study was undertaken to evaluate the various strategies currently in use to manage complex cysts and specifically address the need for intervention. MATERIALS AND METHODS. A review of 4562 breast sonograms obtained during an 18-month period revealed 308 complex cysts in 252 women. Data collected from review of patient records included the patient's age and risk factors for breast cancer, aspiration or biopsy results (or both), follow-up imaging studies, and management recommendations. RESULTS. Management recommendations for complex cysts were 1-year follow-up in 13 patients, 6-month follow-up in 148, sonographically guided aspiration in 82, aspiration with possible core biopsy in 62, and excisional biopsy in three. No malignancies were diagnosed in the group treated with follow-up imaging, sonographically guided aspiration, or excisional biopsy. One malignancy, a papilloma with a 3-mm focus of ductal carcinoma in situ. was diagnosed in one of the patients who underwent core biopsy. CONCLUSION. Of the lesions classified as complex cysts, the malignancy rate was 0.3% (1/308). This malignancy rate is lower than that for lesions classified as probably benign using mammographic criteria (i.e., for lesions classified as category 3 lesions using the Breast Imaging Reporting and Data System). Because the accepted standard practice for management of probably benign lesions is follow-up studies, the low yield of malignancy in this series suggests complex cysts can be managed with follow-up imaging studies instead of intervention.
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Thanks so much Beesie for the info! I greatly appreciate it. I am calling my gyne today to discuss my options, but I think I am leaning towards a FNA. I don't think I can wait six months knowing I have a hard lump that I can feel.
I should add that I have a rather rare autoimmune disease (1 in 100,000), so even when I read a low percentage rate on something, I am still concerned. Your information was the first I read such a low malignancy rate, other studies I found were higher. I found another study that was done more recently:
Breast cysts are the most common cause of benign breast masses. Simple breast cysts do not need further evaluation, but complex breast cysts require additional assessment due to the potential presence of malignancy. However these complex cysts have rarely been examined and quantified according the associated cancer detection rate. Our study is the first investigation that evaluates the malignancy rate of complex breast cysts identified by histo-pathological results. Material and Methods: Imaging findings of complex cysts were correlated retrospectively with clinical and pathologic outcomes. Results: 150 complex breast cysts were found in 132 women. We detected a high malignancy rate of 14%. Sonographic criteria of a complex cyst such as thick cyst wall (p=0.0006), lobulation (p=0.01) or hyperechogenicity (p=0.04) were predictive of neoplasm. Two or more criteria combined were associated with a 13.6 - fold higher risk of malignancy (p<0.0001). Menopause status, family history or personal history of breast cancer did not influence the detection rate of neoplasm. Conclusion: Based on our results we raise the issue for the need of surgical intervention, compared to observation by ultrasound of complex breast cysts to prevent a missed or delayed diagnosis of breast cancer.
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kel,
Interesting information. Do you have the link to that article? I'd be interested in reading it and I haven't come across it in my research. I've had so many cysts over the years that I've read up on cysts quite a lot and I've rarely seen anything where the malignancy rate was higher than about 1%. Here are excerpts from articles detailing 4 other studies:
One of 243 (0.4%) lesions proved malignant (95% confidence interval 0-1.94%); 210/243 (86.4%) of cases yielded fluid on aspiration. http://lib.bioinfo.pl/pmid:18423318
In one follow-up study, cytologic examination found atypical cells in 1,677 of 6,782 cyst fluid aspirates. No cancers were identified. http://www.aafp.org/afp/20000415/2371.html
Cystic malignant growths of the breast are not common with an incidence of 1% of all carcinomas of the breast. In one study 1.6% of the total of 503 carcinomas seen over a 10-year period and 0.8% of the cysts aspirated turned out to be cystic carcinomas. http://www.medscape.com/viewarticle/555606_4
A review was conducted of 401 women who presented with breast lumps thatproved to be cysts....Of the four patients with malignancy, only one hadan intracystic carcinoma, two had necrotic grade 3 ductal carcinomas, andone had a malignant phyllode tumor. http://archsurg.ama-assn.org/cgi/content/abstract/124/2/253
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Thank you kel3420, very interesting indeed.
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Interesting. I was hoping that I could find the full article to read more but it seems to only be available if you have a subscription, which I don't have. I was wondering why this particular study found such a high rate of malignancy compared to all the other studies.
Based on another article I've found, I'm thinking that perhaps the difference might be caused by what was included within the definition of a cyst. The findings in the following study show that all simple cysts as well as all complex cysts that were fluid-filled only were benign but "cystic masses" that included a solid component had a high rate of malignancy. To me, that's an important distinction and the results make more sense. A cystic mass that includes a solid component is different from a standard simple or complex cyst. While I understand the 6-month follow-up approach for standard cysts (but personally would always prefer an aspiration anyway), I would certainly hope that no radiologist or doctor would suggest a "wait and see" approach for a cystic mass that includes a solid component.
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Beesie, I had assumed that a complex cyst was the same a cyst with a solid component. I guess I'm off to google and discover the difference. I have one of these bad boys on an ovary and we're playing the every 6 wk US to see if it changes game. I've not cared to deal with it as the bc journey was sucking up enough energy
. I guess it's time to start paying it some attention. Might I just add that it's so darn cool that brilliant people are here to share their knowledge and I get educated for free!!! Thank you -k
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Simple cysts are round or oval, have smooth edges and are totally clear. Complex cysts are anything else. The edges might not be completely smooth or the shape might not be a perfect circle or oval or there may be some debris inside (which is not the same as having a solid component). I recall reading somewhere that because the definition of simple cysts is so precise, a lot of really basic cysts end up being called 'complex' cysts. Unfortunately I can't find that article right now. But if you look at the study that I linked in my previous post, they detailed 6 different types of cysts. Simple cysts were type I; I'm guessing all the rest would be called complex cysts. Types II, III and IV were all fluid filled; only types V and VI had a solid component.
Of course, that's breast cysts only. I really don't know if the definitions are the same for ovarian cysts.
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Be careful with following up in 6 months.. ESPECIALLY if you have extremely dense breasts. I had a lump back in October 2008 that they said was just a benign cyst and that I should just follow up in 6 months... it continued to grow and became really tender, so I asked them drain it. They took another set of films before they drained it in May 2009 and again say that it was a wait and watch type situation, nothing to worry about. I insisted on having it drained anyway, due to the location and it bothering me. When they went to drain it, they found that it was not a benign fluid filled cyst after all, but rather a solid 2-3 cm malignant tumor.
On the other hand though, back in October they found 3 complex cysts on the OTHER breast (not the one with the tumor) that they wanted to aspirate, and they all turned out to be benign fluid filled cysts...
So if you are worried about, have them drain it. The fine needle biopsies dont hurt at all if they use a local anesthetic.
Amy_T
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This is really great information gals! Good to see this come up again in recent posts!
I have TONS of cysts and have both simple and complex. I've had multiple aspirations and a few biopsies. There's no way to have every single one of my cysts aspirated there are that many. The large ones (6cm and 5cm) have been drained and have refilled multiple times even right on the table under sono guidance. It was filling as fast as it was being drained. That bothers me a little. I also have a cyst located in/on a thickened duct wall that has been bx and is being watched.
KEL: please find a breast specialist and make an appointment. You should be treated as though you are the only patient in the practice when it comes to your questions and concerns. I agree with Amy and the best phrase I've heard around here is: the only place for a lump is in the jar. I am seen by my surgeon every 3 months. In fact, I go back the 30th again. (ugh but hopefully no needles or scalpels this time
)Beesie: I love all your information. You're so good at helping to explain things to people. Thanks for being here and know that you're appreciated.
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Kel,
This is all great information but first and foremost you know your body and if you are not comfortble waiting than don't. Tell them that you are concerned and that you would like to be certain and to please schedule a FNA. You have to look out for you. Dr's make mistakes just like every other person in every other job.
I was told I had a complex cyst and that they would recheck in 6 months. I knew I couldn't wait that long and I am glad I didn't. It changed and brought enough concern that I now have a BS have gone for an excisional biopsy and am waiting for results. There is no way I could have waited until November for another mamo and ultra. Ask questions, research and ask more questions until you feel comfortable with the answers.
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Beesie,
I read the full article kel cited and the 13.6% chance of malignancy in a complex cyst was what got me in a panic...I liked the 0.3% so much more
. This was a retrospective study (2000-2006) on only 131 women, and the sole inclusion criteria was a diagnosis of "complex cyst" by review of mammographies and ultrasound studies by two independent radiologists. The data were broken down into histologic findings as well as sonographic and mammographic characteristics, which was interesting, but 131 women is not a large cohort by any means. Kel, what sizes are your cysts? Mine is 4mm and I wonder is a FNA can be done on something that small? I can't deal with any more watch and wait stuff either and am headed t a BS Aug 3 and will bring my own paring knife, if needed, to just get it excised and done with. Patience is not one of my virtues. Good luck and don't wait.....it's your body.
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I went to have my yearly mamo and I got a notice that it was BIRAD 0 and needed more views. Went for more views and I got another BIRAD 0. Next step was the US. After US was done, they are recommending a biopsy. It was a BIRAD 4. A cluster of cysts with one complex of 3 mm deep down. They will do an ultrasound guided biopsy on the complex one. I am, of course, very worried. When I found this site, I felt such a comfort as I know lots of you are going through the same thing. I am 52 years old.
M27
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I'm 50, with normal mammograms. A year ago my routine breast US picked us a 4mm hypoechoic cyst/nodule that was presumed to be a complex cyst. A repeat US 6 months later showed not change, and another follow up yesterday came back "Again observed is a well-circumscribed hyopechoic nodule measuring 4-5mm in size. Well defined margins and posterior acoustic enhancement are observed. No significant change". BIRAD 3
The logical part of me know this is probably benign, but I am a bundle of anxiety about the "probably" part. I have an appt with a breast surgeon Aug 3. I want the darn thing OUT, but I suspect he'll want to do a FNA or CNB. Should I go with a biopsy, with a chance that the sampling won't catch all that may be part of the cyst?
My husband is a cancer survivor on a three month follow schedule and the watch and wait stuff is hard for me to deal with. This is a wonderful site, Thanks!
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Qutoing BEESIE:<<< If none of the 'concerning' characteristics are present, there is no reason to take any action with a cyst. >>>
Yes, have the FNA, Kel3420! No one, not anyone, should try to persuade someone from not looking into something. It's not "her" body.
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Due to a cancellation, my bs appointment was moved from Aug 3 to this Friday...yeaaaaaa!!!!
I'm trying to convince myself that 4mm complex cyst that has not changed at all over the course of one year, BIRADS 3 on an ultrasound, negative mammos, will be OK. I am reading a lot about complex cysts and bc in general and working myself up to panic attacks. But I am also reading a lot on this site, and am empowered by all the amazing women, the knowledge, and the compassion.
My question is this: if the bs wants to do a FNA or core biopsy, and I just want the darn thing OUT, will a doc agree to excision and do insurance companies have a problem with that? Thanks!
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I am in a panic about this complex cyst.....I wish I could get myself under control but I am terrified that this won't be benign. I have a 12year old daughter with two friends who lost their moms and I am petrified for her to face the same. I have 72 hrs left before my appointment and I am a wreck. Please, please, if anyone had a complex cyst I would so appreciate comments on that it was described as on an ultrasound or mammo and what it turned out to be. I know I am being irrational but I just can't get a grip.
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Cookiemom:
I've had more than one complex cyst. I've had multiple cysts aspirated and have had biopsies on the complex cysts because they have both fluid and solid components and/or debris floating in them. My findings have always been benign. I've lost friends to BC and I have friends who have come through the fight just fine! I also have two teenage daughters. I know this waiting totally stinks and it's just another life stressor to deal with. You can click on my name and read some of my other posts or feel free to send me a PM.
Remember that 80% of lumps biopsied are BENIGN!! Hang in there!
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Thanks for the response. I want to go to the doc Friday and have the darn thing taken OUT, but I know there's the wait for that and the wait for the pathology. How large have your complex cysts been, and is stable for a year a good sign? 0
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I can exhale now
and actually sleep tonight. The bs is certian it is B9....4mm a year ago, 4mm now. I want it out anyway, so on Aug 5 I go for a needle aspiration and if that doesn't work because of the small size or the composition then he's going directly to excision. I hope to post a B9 path report mid August! Thanks so much for the wisdom on this site and the shared experiences. Special thanks to bygrace17 for her encouraging PMs. I'll be keeping track of you for your end of month appointment Grace!
Karen
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Karen, that's great news that the BS is certain that your cyst is benign. And hopefully the needle aspiration is successful and takes care of everything!
Momcat, I hope that you didn't interpret my earlier post as suggesting that an aspiration shouldn't be done if someone is concerned. That's not my belief at all. My comment "If none of the 'concerning' characteristics are present, there is no reason to take any action with a cyst" related to the fact that so few complex cysts are malignant, and those that are malignant show specific characteristics on ultrasound films. This means that medically an aspiration is not considered to be necessary if those characteristics aren't present. But I immediately followed that statement with the following comment "Having said that, I've had lots of cysts over the years and my doctor always preferred to aspirate them right away." and then went on to say "I know that most doctors don't automatically aspirate cysts but if you are uncomfortable waiting 6 months for a follow-up ultrasound, there is no reason why you can't request that your cysts be aspirated." So I fully support pushing for the aspiration of any cysts - but I also wouldn't want any woman reading this who has had cysts that were not aspirated to worry that she did not get the right treatment or that she should have insisted on an aspiration. Either option is okay; what's important is that we are each comfortable with the approach taken in our own cases.
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I had a small complex cyst aspirated today. Had a routine mammo and US done monday (as I have a number of benign lumps, one of which was removed 2 years ago). My BS called Monday afternoon to say I needed a biopsy as the edges looked fuzzy, it was hypoechoic and it had grown. He wanted it done before I see him next week. It turned out the edges were fuzzy because the cyst was so deep inside the breast, and once the fine needle was inserted and the fluid removed it collapsed. The dr doing the biopsy is pretty certain it is benign because it collapsed, but is sending the fluid off to the path lab ayway because it is thick. Results will be in by the time I see my BS for my annual check next week, but at this stage, it looks like it is nothing. I didn't feel the lump becuase it was so small (8mm) and so deep. Lessons learned - make sure you do your regular screening, take your old films with you and most of all, don't sweat about it too much - the vast majority of these things are benign!
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Dear all,
Your knowledge and kind words for each other in this thread has helped me calm down in the 3 panicky weeks I've had since I found a lump on my right breast.
The mammo doesnt show microcalcifications, but the ultrasound shows 3 cysts, not just one. Two of them are on my left breast, 7mm and 9 mm, hypoechoic, no vascularization. The radiologist stated in the report that they might be complex cyst/small FAM.
The one cyst on my right breast, the one I found, is 14.5mm, anechoic and shows vascularization on the edge. In the report it is stated as "suspect complex cyst or infected cyst".
I went to an oncologist surgeon who said the first 2 cysts were benign and could be left alone. The big one on the right "needs to be aspirated or removed surgically, but is most probably benign", according to him.
What are your thoughts? The one thing that puzzles me is the vascularization part, I thought it meant blood supply and cyst shouldn't have blood supply?
Any input will help a lot.
Thanks ladies!
Sending everybody vibes for health and peace of mind.
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Hello Sparklingrain.
I'm impressed this thread is still alive considering it started years ago, and like you I felt glad I stumbled on it because on the most part I didn't feel alone. I honestly don't know how to answer your question, but I also have a complex cyst and due for biopsy in less than 48 hours. I'm seriously freaking out inside but it did help reading that a lot of people did the biopsies and most results come out benign. I think the most horrible part is the "waiting" time.
Hopefully someone from the previous posts can answer your question and all the best luck for both of us
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I'm due to have a FNA tomorrow for complex cyst with debris. They seem to be making it a pretty big deal, not the procedure itself, but the tech's words to me were, "If it is cancer this is the kind to have". UH, huh? They also told me about Core Needle biopsy as if it were a given.
Is that supposed to make me feel better? Sigh.
SO, Remote, looks like we are doing this stuff the same day. Good wishes to you.
All, I'm fairly medically knowledgeable, but these terms are new to me. What's the difference of a complex cyst with debris and complex nodule? Thanks!
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I have dense breasts. They been following me every six months since forever. I am 57 this year. Last May, I had my mammo and US and the US tech was marking up a few "cysts." I usually watch so I can see they are looking at the clear, well defined fluid areas, which I am loaded with. I have had two or three aspirations, and a previous lumpectomy. At FIRST, my biopsy came back benign. I thought the heat was off, but due to the type of tissue (some papalomas) they wanted a lumpectomy. I was not wild about lumpectomies, as the last one killed the feeling in my nipple. Well, before they did it, I asked for a breast MRI, also was clear of malignancy. So, I get the lumpectomy and a week goes by. I call my doctor and they nurse says the doctor will call me later in the day. She does, and I am NOT BENIGN. I had stage zero...aggressive DCIS. Big bummer. At least we got it early. I have such problemmatic tissue, I had them do a BMX. Honestly, I nearly blew off this mammo as I just had a knee replacement in Jan and was sick of the doctor's office. I almost said no to the lumpectomy due to the benign biopsy. Be careful ladies. The only lump belongs in a jar...I like that saying I read in here.--Lisa
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I wish someone made a color coded chart....'watch' to 'danger will robinson!" So many terms, so confusing. Where does a complex intercytial cyst fall in comparison to a papilloma? Or is one a variant of the other?
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Hi River
I wish I read your message before I did the biopsy! It helps to know someone else was with me in the same boat the same day hehe. So how did yours go?
Mine went well but I hated my surgeon. I didn't feel any pain during the procedure but the odd thing is that I still feel pain especially when I run down the stairs or exercise or move my arms in a certain direction. I was worried cuz they told me I shouldn't feel any pain by now.
Do you still feel pain too? Or is it just me?
Anyway, I went and saw a second specialist and she told me she's totally against putting a needle into a cyst unless there's absolutely a need for it. Often aspiration is useless cuz the fluids will just come back once you PMS again.
I'm scheduled for an MRI next month. The aspiration results came out okay but they still need to investigate for sure about the little thing... whichever it is (not very familiar with the terms)
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Glad to hear they got it early. Can I ask how big was the lump, if you don't mind? Also was it a complex cyst that turned out to be not benign?
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