Expert: Claes-Gustaf Nordquist, M.D. - 10/7/2006

Question
I recently went in for my annual exam and OB found a possible cyst and sent me for a mamo, the mamo showed markedly dense breast tissue, so they went right over and had me do a u/s, which showed a cyst at the 3 o'clock hour that was 4 mm, and then the radiologist was brought in and spent some time messing with the ultrasound and looking and enhancing, and then told me that even though not palpatated that he found a 5 x 11 mm hypoechoic lesion at the 1 o'clock hour, and that I would need to come back so later then 3 months to repeat a follow up u/s and then a biopsy.  He said it is probably bening, but to come back if there are any changes, and now I have had massage therapist and family say it looks as if the left breast is larger and the nipple looks as if it is sinking is some, exspecially when laying flat.  What does all of this mean and should I persue this sooner?

Answer
The described cyst is not alarming. If the radiologist has found a hypoechoic lesion (an area with less sound echo back to the machine - it works like radar but with sound waves instead of radio waves) I do not understand why you must wait. I think it is better for you to have the result as soon as possible. I therefore think that you should demand the following: 1. a thin needle aspiration biopsy guided by ultrasound of the hypoechoic lesion to be able to rule out if possible any malignancy there at the same time a similar biopsy can be made of the cyst to be on the safe side, 2. as a complement to the x-ray mammograms (difficult to interpret due to your dense breast tissues, which is normally the case in such a situation) and ultrasound scans a breast MRI scan should be made. If these things are done and nothing pathological is found you will be on the safe side for the time being. Good luck!