Expert: Claes-Gustaf Nordquist, M.D. - 4/12/2008

Question
QUESTION: I had a mammo and ultrasound which revealed 2 complex cysts in my right breast and a simple cyst in my left breast. My GYN advised to have the cysts aspirated. I wanted to wait to see if they would go away. she referred me to a surgeon and she also advised FNA. The results came back atypical cells found in the fluid. Now I need to have a more extensive biopsy to rule out cancer. I am scared and confused because there was never an indication of a solid mass, they were just cysts found. I feel that the FNA has opened up a can of worms and I don't know how to proceed. I am 39 yrs old and no history of breast cancer in my family. Pleae advise, Thanks.

ANSWER: Atypical cells are not the same as cancer, but they may indicate that a cancer later would develop there if nothing is done. So see this as a possible opportunity to take care of the situation and hopefully stop any such development. Knowledge is the key to possibilities and opportunities while ignorance may be a trap! So I strongly do suggest that combined "lumpectomies" & surgical biopsies are done on these lesions so that they are all completely removed. The pathology reports will then tell where you stand! Please do keep me posted! Good luck!


---------- FOLLOW-UP ----------

QUESTION: Thank you for your quick response. As you stated, atypical cells are not cancer and I have read that they can resolve on their own. Also, I heard that atypical cells can develop due to inflammation caused by the aspiration itself. Is this true? I have also read that the color of the fluid can indicate abnormalities and I was told that I had nothing to worry about.I am reluctant to do anything invasive without having the facts. Surgery should not be considered lightly. I do believe that information is key and that is why I am doing my research. I am thinking about getting a second opinion. Do you think this is a good idea? I just feel there are alot of question marks and more to come....Any info or advice would be appreciated. Thanks

Answer
Yes atypical cells can resolve on their own. HOWEVER that is MUCH LESS likely in a breast than for example in the uterine cervix (checked with pap smears). So your risks are bigger here. Furthermore it is NOT true that atypical cells develop due to the aspiration itself! The technique has now been used for around 50 years with very good results. A former boss of mine, Professor Sixten Franzén, M.D., Ph.D. now deceased, was one of the pioneers of this technique. Yes if there is blood in the aspiration fluid the risks are higher, but that is by no means a sure sign. You can NOT tell the patient that there is nothing to worry about by just looking at the fluid with your naked eye. To deliver any kind of statement microscopy of the fluid sediment is necessary. These are the facts. We are not discussing major surgery here. What is being discussed is minor routine surgery, very much like ordinary surgical biopsies. And I stick to my support of such minor invasive action since I regard that to be in your best interest - that is why I at all answer questions here free of any charge or any other financial benefit! It is never wrong to ask for a second opinion, but do not let it develop into a third, fourth or even fifth opinion because you will have lost time by doing that. The big question mark here is if you have a cancerous lesion or not and the ONLY way to KNOW if that is the case or not is now by surgical biopsies. Please see my previous answer.