fine needle aspiration

[gradysmom]

I have posted here before and am tremendously thankful for your site. Over the last six months I have seend many doctors re: changes in my left breast. Have had three ultrasounds and one mammogram. Findings include dense breasts and three cysts. One cyst which was labeled complex is now considered simple. I continue to have a lot of pain and feel that the area where I have these cysts is becoming thicker. Saw my breast specialist last week and she finally did a FNA of the area where I feel thickening. The results were not completely conclusive because findings were only fatty tissue and fibrous tissue. They were not able to obtain any real breast tissue which I was told would give us a definitive answer regarding any atypical or malignanat cells. Should I feel comfortable with this or should I ask for a more definitive test such as a core biopsy? Breast Specialist wants to see me back in three months, but only because she said that is policy after a procedure such as FNA. She thinks I have nothing to worry about. What do you think?

[jrb27]

I have a lump in my armpit that aches and has been there for almost 8 months.  I have had a mammogram but they couldn't see anything because my breasts are dense.  I had an ultrasound and they said it was 2.4 cm and thought maybe it was an enlarged lymph node.  The first surgeon I saw said it didn't feel pathological but that he would remove it.  I sought a 2nd opinion, he at first thought I was crazy because he couldn't see it (even though it is obvious to me), then thought it was fatty tisse but then felt it and said maybe it is swollen breast tissue.  I didn't like his attitude so I went to one more surgeon and he reacted the same way at first but then felt it more and said he would at least do a fine needle aspiration even though I think he really thought it was the "tail of spence".  I haven't gotten the results yet but I feel weird because noone seems to take me seriously.  How can I have this swollen breast tissue that hurts in one armpit and not the other?  Also, I had an inflamed swollen milk duct in that same place when I was nursing my 2nd son.  I am just afraid that I could miss early signs and I have 3 kids so I'm pretty worried about it.

[americankiwi]

go now.  If nothing else it will ease your mind, waiting and wondering is the worse.  Make sure it is a core biopsy and they take at least 6 samples.  This cancer probably started about 7 or eight months ago but it started as a cyst.  It just changed, it became harder but not real hard like you would expect cancer to be.  I noticed the surgeon has said to check it out also. Being frighted is not fun or good for you.

Let me know how it goes, remember the chances are its probably nothing but why take the chance.

Wishing for the best!!
Wendy

[gradysmom]

What were your symptoms exactly? When did you start having them. You mentioned you have had cysts for the past twelve years. Do they think you have had cancer that long? I started having pain in my left breast early this year and have since had three ultrasounds, one mammo, and one FNA. All tests have been negative. The mammo showed only dense breasts. All three ultrasounds show cysts in various areas of my breast and the FNA showed fatty and fibrous tissue. I have been to two surgeons (one a breast specialist at a major cancer facility in TN) and have had three radiologists review films. I was feeling somewhat more comfortable, but after hearing your story I am scared again. I had not even thought of lobular cancer and none of the doctors have brought it up. I am supposed to go back in January for follow up. Do you think I should wait or make another appt. now?

[surgeon]

just for the record, I would not consider a hard area that was growing,  as haviing passed the physical exam part of the triple test. So in that case, no matter what the xray showed, I'd want to do a biopsy; if the fine needle showed cancer, then there'd be no reason to do more of a biopsy. But if it didn't I'd do an open biopsy. Again, the key thing about the triple test is that each part must be clearly benign. And an enlarging firm lump is never clearly benign until proven so without doubt.

[americankiwi]

Dear gradysmom,

I had the same symtoms as you.  I am 42 and had problems with breast cysts since I have been 30.  The place where I always had the same cyst started to become thicker.  I started having pain there also.  I did not worry too much as I always had a cyst there and heard that cancer does not hurt.  The thickening did not go away but got worse.  I went to the Dr and because of my past he did an aspiration.  This came out neg.  I also had a mammogram which came out neg.  The Dr and I had a bad feeling about the "thickening" so the same day I had a core biopsy.  I have lobular cancer stage 2 with 3 nodes pos.  I had a mast 2 weeks ago and start chemo in a couple of weeks after more tests.
I am not trying to scare you but am telling you to insist on the core biopsy.  Lobular cancer only is diagnosed in 5 to 10% of women but is like a "ghost" cancer as it frequently does not show up on mammos or ultrasounds.  As I said I don't mean to scare you but please please demand a core biopsy.  Let me know how it goes.

Am sending out positive feelings for you that everything is OK.

Take care
Wendy

[surgeon]

There's a concept known as the "triple test," meaning if a mammogram of a lump looks ok, the area feels ok, and a fine-needle aspirate shows no suspicious cells, the chance if missing cancer is extremely low. Since you are seeing a breast specialist, and have had a triple test (I assume she thinks the area feel ok), the chances of being wrong are very low. However, it's also about your feelings: if you are uncomfortable and will worry until more is done, you should let your doctor know. I've done many a biopsy just for peace of mind (I've never had one turn out bad when the triple test was ok and when I was the one who did the exam and the FNA) and consider it perfectly reasonable if that's what the woman needs to sleep at night.

[CCF-RN,MSN-rf]

Dear gradysmom:  If this is cystic, then there is little chance that this is cancer or anything to worry about.  A core biopsy may give more information if you can figure out, either mammographically or ultrasonographically where one needs to biopsy.  Otherwise, you may get similar results.  You could have this thickening excised completely, which would be definitive in terms of providing a "once and for all" answer but could be overkill and result in a potentially less cosmetically pleasing result, depending on the size of the thickening and amount of breast tissue.  Another option would be to take your films and pathology  slides to another breast specialist and get a second opinion.  Perhaps another opinion will give you the peace of mind that you seek.