atypical results from cyst aspirations

[wicki]

I am 50 years old, had a lumpcectomy 10-03, stage IIA breast cancer - sentinel node biopsy - negative - margins clear - Her-2/Neu very positive - 25plus. I went through CAF chemo and taxotere - 8 rounds - every 3 weeks.  Also, 34 radiation treatments.  This was the right breast.  On the left breast, I had a cyst aspirated (in the office) in March, 2004 - it returned full size by July - had a digital mammogram and an ultrasound.  The radiologist aspirated 6 cysts and did 3 core-needle biopsies on solid masses - I asked her to send the fluid in and she was happy to but said it "looked" fine.  She only sent it in on the big cyst.  I then had an ultrasound on my right breast (just completed radiation 1 week prior to this).  2 masses that were biopsied same way and 2 cysts aspirated - she sent this in on her own - one came back atypical - the biopsies were begign.  The radiologist was extremely concerned and after talking at length with her - I was convinced I wanted a double mastectomy - my breasts have such dense tissue - nothing has ever shown on the mammogram - just on the ultrasound.  I feel like it is a time bomb for me.   My surgeon  said "we should have thrown the fluid away" many different things could have shown atypical.  The were done on 2 separate days and read by 2 different techs.  I am scheduled to have an excisional biopsy on Friday, for the 1 area on the left breast - surgeon said he was not concerned about the right breast because it was on the former tumor site.  What has been you experience with this ?

[Catherine the Great]

I had a mammogram in May and there was a cyst in my left breast. The radiologist wrote my report as 'normal'.  In July, the cyst grew to the size of a boiled egg and I went to my dr for removal of fluid.  He drew 20cc out of that one and 15 cc out of one just below it.  He didn't test fluid from either one. I felt another cyst below those and went in a week later, he drew another 8cc from that one and didn't test it, either. A week later, the largest cyst at the top of my breast was filling again.  I REQUESTED an ultrasound.  The results showed three cysts and the radiologist recommended a biopsy.  I was not comfortable with the surgeon that is assigned to my family doctor, so I took my results to a surgeon I know and asked his opinion.  He immediately drained the top cyst AGAIN and sent the fluid to the lab.  Lab results showed atypical cells.  My surgeon is going to remove the cysts in September because he would rather be sure than sorry and so would I.  COSTS?  WHAT IS A LIFE WORTH!  Doctors have no right making decisions by statistics OR cost.  That is YOUR right to decide as a patient. As for me, my life is worth it and I'M NOT A STATISTIC!

[surgeon]

I agree with your surgeon: sending in cyst fluid is almost never useful, and often gives results like yours which lead to worry and biopsies that end up ok. Data show quite clearly that if cyst fluid is clear yellow and the cyst goes away when drained (meaning there's no residual lump at the time of the drainage), the chance of cancer is virtually zero, and sending the fluid in adds nothing but cost. Having gotten "atypical" results, it's hard to ignore at this point; but it'll turn out benign virtually certainly. Prophylactic mastectomy is always an option for the woman who feels she'll be too frightened not to have it; but the decision to have it would be based on personal considerations, rather than on specific data.

[CCF-RN,MSN-rf]

Dear Wicki:  In general, fluid from cysts does not add to the diagnosis.  If the fluid is clear-yellow and the cyst goes away, it is almost always benign.  Now that you have atypical cells, you will certainly feel worried until it is investigated further.  A bilateral mastectomy can be a reasonable option for high risk women who don't wish to worry about the breasts themselves.  I am not certain that this decision should be based solely on the results of this aspirated cyst.