Irregular Breast Cysts: Ultrasound Insights and Next Steps

Breast ultrasound shows irregular cyst margins with fine needle aspiration?

Hello Dr.
Yuan,
In 2016, I was diagnosed with small fibrocystic changes, which I initially did not take seriously, but I have been undergoing annual ultrasound follow-ups.
During yesterday's ultrasound examination, the doctor mentioned that there are now four larger cysts, approximately 1 cm in size, and three of them have irregular and indistinct margins, requiring further evaluation through fine needle aspiration and biopsy.
Additionally, the smaller fibrocystic changes have increased in number, and both breasts are affected.
I would like to seek your professional advice on the following:
1.
Since the ultrasound was performed one week before my menstrual period, during which I typically experience breast swelling, could this be the reason for the increased number and size of the cysts? Is it possible that the fine needle aspiration may not be necessary? Should I wait until after my menstrual period to have another ultrasound for confirmation?
2.
Does the interpretation of ultrasound results vary depending on the equipment and the physician? Should I consider getting a second opinion from another physician before deciding on the fine needle aspiration?
3.
I have been trying to conceive for the past six months and have scheduled an appointment with my doctor in two weeks to confirm if I am pregnant before proceeding with the fine needle aspiration.
However, if I am pregnant or if malignancy is detected, will I have to choose between treating the tumor or continuing with the pregnancy? I am already 33 years old, and if it is malignant, I fear I may not have the opportunity to have children.
4.
I lead a very health-conscious lifestyle, so I am puzzled as to why there is a suspicion of malignancy.
What are the potential causes of tumors?
5.
What is the likelihood that a biopsy will confirm malignancy based on ultrasound findings?
Thank you very much for your time and responses!

Cathy, 30~39 year old female. Ask Date: 2021/03/17

Dr. Yuan Tianmin reply Breast and Thyroid

In general, if there are any unusual appearances during a follow-up breast ultrasound, it is advisable to perform a biopsy to confirm the findings.
You shouldn't worry about whether the biopsy results are benign or malignant, as knowing the results is essential for determining the next steps in management.
This procedure is not related to pregnancy, as the biopsy performed prior to the ultrasound does not involve radiation exposure, so pregnancy is not a contraindication for this procedure.

Reply Date: 2021/03/17

More Info

When it comes to understanding irregular breast cysts and the next steps following an ultrasound examination, it is essential to consider various factors, including the characteristics of the cysts, the timing of the ultrasound, and the implications of the findings. Based on your inquiry, let's address your questions systematically.

1. Impact of Menstrual Cycle on Ultrasound Findings: It is well-documented that hormonal fluctuations during the menstrual cycle can affect breast tissue. Many women experience breast tenderness and swelling in the days leading up to their period, which can sometimes lead to the appearance of more cysts or larger cysts on ultrasound. However, while hormonal changes can influence the size and number of cysts, the presence of irregular margins and indistinct borders in cysts is a more concerning feature that warrants further investigation, such as a fine needle aspiration (FNA) or biopsy. It may be beneficial to discuss with your physician whether a follow-up ultrasound after your menstrual cycle could provide clearer insights into the cysts' characteristics.

2. Variability in Ultrasound Interpretation: Yes, the interpretation of ultrasound results can vary based on the equipment used and the experience of the radiologist or technician. Different machines may have varying resolutions, and the skill and expertise of the interpreting physician can influence the findings. If you have concerns about the interpretation of your ultrasound, seeking a second opinion from another radiologist or breast specialist is a reasonable approach. They may recommend a repeat ultrasound to confirm the findings, especially if there are discrepancies or uncertainties.

3. Pregnancy Considerations and Treatment Decisions: If you are actively trying to conceive, it is crucial to communicate this with your healthcare provider. If you become pregnant, the management of any potential breast issues will need to be carefully considered. In cases where malignancy is suspected, treatment options can vary significantly based on the stage of the pregnancy and the nature of the tumor. It is essential to have a multidisciplinary team involved in your care, including obstetricians and oncologists, to navigate these complex decisions. Early detection and intervention are key, and many women have successfully managed breast cancer during pregnancy.

4. Causes of Tumors: The development of breast tumors, whether benign or malignant, can be influenced by a variety of factors, including genetic predisposition, hormonal influences, lifestyle factors (such as diet and exercise), and environmental exposures. While a healthy lifestyle can reduce the risk of many diseases, it does not eliminate the risk of breast cancer entirely. Regular screenings and being aware of changes in your breast tissue are vital components of breast health.

5. Probability of Malignancy with Irregular Cysts: Irregular cysts with atypical features on ultrasound can raise suspicion for malignancy, but not all irregular cysts are cancerous. The likelihood of a definitive diagnosis of malignancy through biopsy will depend on the specific characteristics of the cysts and the clinical context. Generally, the rate of malignancy in breast cysts that exhibit atypical features can vary widely, and a biopsy is often necessary to establish a diagnosis. It is essential to discuss the risks and benefits of biopsy with your healthcare provider, as they can provide tailored advice based on your specific situation.

In conclusion, navigating breast health concerns can be complex, especially with irregular cysts. It is crucial to maintain open communication with your healthcare provider, seek second opinions when necessary, and stay informed about your options. Regular follow-ups and monitoring are essential, particularly when there are changes in breast tissue. Your proactive approach to your health is commendable, and ensuring that you have a supportive medical team will help you make informed decisions moving forward.

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