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hypoechoic solid nodule versus fat lobule
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hypoechoic solid nodule versus fat lobule

I recently had a breast sonography done which showed a 1.0cm hypoechoic nodule. I was asked to return in a month for another ultrasound, which I did, and it showed the same result and also stated that this "indeed represents a solid nodule and not a fat lobule" probably a fibroadenoma. I was scheduled for an FNA which I had a few days ago and the pathology was stated as "suboptimal for evaluation, fatty stroma present, few cells, no epithelial cells present" I was told by the radiologist that this "nodule" was now a fat lobule and not a fibroadenoma as mentioned before. Is this common because I have to say that I do not feel comfortable with being told two different things and I am not sure if the correct area was targetted during the FNA. Shouldn't certain characteristics on the sonography have pretty much detected what it was. I was also told when the FNA was performed that the nodule was '"soft" when he entered it with the needle. Does this make any sense? JJ
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Unfortunately, the situation you describe is all too common.  The one thing you shouldn't do though is worry because the radiologist is just undecided about whether the thing is a fat lobule which is benign and should be left alone, and a fibroadenoma which is also benign and should also be left alone.  

Fine needle aspirations (FNAs) are notoriously unreliable and most places do not do them at all.  Not only do they have high rate of "insufficient material" but they also tend to overcall atypia when there is none, resulting in unnecessary surgeries.  Places that really have their act together will have a cytologist technician in the room during the FNA who actually evaluates the sample right then and there under the microscope to determine whether sufficient material has been obtained to make a diagnosis.  

It is often difficult to distinguish some fibroadenomas from fat lobules, or islands of fat that are surrounding by fibroglandular tissue by ultrasound, but again it is inconsequential anyway.  I guess by saying it was 'soft' when he entered it was his way of saying it was just fat and didn't provide the kind of resistence to putting in the needle you would expect from a fibroadenoma (which is very fibrous).  Plus the cytology report which described 'fatty stroma' supports the probability that it's just a fat lobule.  

Some (risk adverse) radiologists believe every solid lesion needs to be biopsied and every cyst that is not completely simple needs to be aspirated.  The literature firmly supports that it is perfectly safe to instead follow most of these at periodic intervals for two or three years to make sure they are not changing and then declare them benign and forget about them, unless they have suspicious features, like an angular or irregular shape, or fuzzy margins, etc.    
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