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AskedPublicly Submitted Question
2/13/2018General question: Should I have another exam before agreeing to aspiration of cyst?

I am 48 and have a very strong family history (mother, grandmother, sister, aunt on maternal side with breast cancer) and Level IV breast density. My lifetime risk factor is rated as 32.8%.

My main question is: is it advisable to have an additional EXAM (Ultrasound or MRI?) to have another look at cyst on left breast at 09:00 position before agreeing to have an aspiration of this cyst.

I ask because exams on 01/05/18 and prior didn't show anything on this cyst. Doctor I went to see on 01/26/18 for second opinion did his own Ultrasound. I also reported - as I have been doing for the last few exams - a newly inverted on the left breast.

Results from these exams on 01/05/18 and 01/26/18 are below.



On 01/05/2018 I had 3D Mammogram and Ultrasound and these were the findings:

Mammogram: COMPARISON STUDIES: Exam is compared with prior studies in 2015 and 2016.
FINDINGS: Breast parenchyma is very dense. Scattered parenchymal calcifications are
observed. Microclip is noted lateral left breast. No suspicious mass or calcification
is observed. No significant interval change is identified.

Ultrasound: There is a simple cyst left breast 9:00 axis 2 cm from the nipple
measuring 6 x12 x 13 mm. There is an adjacent 4 mm simple cyst. No suspicious solid
lesions observed in either breast. No suspicious adenopathy.

On 1/26/2018 I visited a DIFFERENT Dr. for a second opinion, and he did another ultrasound.

Limited left breast ultrasound was done in the retroareolar region on the left and to
take a second look at the cyst down to be present at the 9 o'clock position on the
left. Along the medial wall of the cyst there is some irregularity and some
hyperechoic tissue suggesting some solid tissue material perhaps in the form of
particles or a small papillary growth at this location. A few slightly dilated ducts are noted in the retroareolar region on the left but I do not see any significant pathology appreciated. Visual exam of the breast reveals no erythema or edema. There is a subtle
inversion of both nipples. The right nipple presents as chronic and the left nipple
presents recent inversion. No fixed inversion of the nipple was seen, in that the nipples easily become everted with gentle pressure on either side of the nipple.

Return scheduled for ultrasound-guided cyst aspiration for cytology on the left
under ultrasound guidance and through a separate puncture wound with Xylocaine
behind the tissue to aspirate the retroareolar region on the left looking for any
abnormal tissue, including looking for any abnormal cells such as Paget's cells.


Again the question is: is it advisable to have an additional EXAM (Ultrasound or MRI?) to have another look at cyst on left breast at 09:00 position before agreeing to have an aspiration of this cyst. As a side note, my last MRI was in April of 2017.
RepliedJHU's Breast Center Reply
2/13/2018The recommendation is that the cyst be aspirated to analyze the cells inside, which is what we would do. You can always get a second opinion.

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