Birad 4 Finding -- Mural Nodules in Breast Cyst

I have recently had a mammorgram, followed by a spot compression and ultrasound.  I am going to a breast surgeon next week and have not told my 80 year-old mother because I don't want to scare her unnecessarily.  But if the following description sounds like there is a probability of cancer, I would like to alert her to a problem so if it is indeed diagnosed as cancer it will not come as a total shock to her.  I am 46 years old and have not gone through menopause.  The Impression from the Radiology Report states:  Complex appearing retroareolar nipple cyst left breast.  Sonography shows purpose of mural nodules.  This is categorized as a Birad 4, suspicious.  Correlation with cyst aspiration is requested and follow-up ultrasound to evaluate if there is persistent and visulation of the mural nodules.  A few other comments noted on report:  cyst with evidence of through transmission; maximal size of 1.7 cm; width 9.9 mm.  It is not compressible.  It does not appear to be penetrating through tissue planes.  There are however what appear to be at least two mural nodules within the cyst.  Thank you for your input.

[CCF-RN,MSN-rf]

Dear tmm1959:  A complex cyst is a cyst with separations or walls.  Mural nodules describes a thickening within the walls that can sometimes be associated with a cystic cancer.  A cyst aspiration may not be adequate to determine the nature of the nodules.  Therefore, a biopsy is often recommended.  Most of the time these turn out to be papillomas but it is important to rule out any malignancy.  A BIRAD 4 generally indicates that biopsy is recommended but a significant percentage of BIRAD 4 lesions turn out to be benign.  There is not enough information at this point to speculate on the probability of cancer.  One way of handling this with respect to your mother is to mention that you are having a biopsy to look more closely at some breast cysts.