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Oct 27, 2008 07:09AM
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.
Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage IA, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke