Aspiration of Cyst

Introduction

Cysts are one of the very common problems. Although they cannot be accurately diagnosed with physical examination or mammography alone, they can usually be diagnosed correctly with ultrasound. In most women, they do not usually require any intervention or follow-up.

Cyst aspirations are performed when a cyst is causing significant tenderness or when the diagnosis of a cyst is doubtful even after an ultrasound.

For a cyst aspiration, patient usually lies on the back or slightly turned to one side with the arm placed comfortably under the head.

The skin is cleaned with betadine and alcohol and then numbed with topical anesthesia. Under guidance of ultrasound, a small needle is inserted into the cyst and suction is applied to draw the fluid out. This causes the lump to collapse.

The aspirated fluid may be discarded or sent for evaluation (if the fluid is bloody). Following aspiration, sometimes cysts may recur.

If breast cancer is suspected following a diagnostic mammography, ultrasound or MRI, one of the following procedures is recommended to establish an exact diagnosis:

1. Fine needle aspiration

2. Needle biopsy

Fine Needle Aspiration

For fine needle aspiration, a small needle is used to aspirate, or suction the cells out of a lump in the breast or underneath the arm so that the cells can be examined under the microscope.

The procedure is safe, especially when done under ultrasound guidance, but possible complications include:

• Infection

• Bleeding

• Pneumothorax (lung collapse) – this is an exceedingly rare complication, particularly when imaging guidance is used for aspiration.

For a cyst aspiration, patient usually lies on the back or slightly turned to one side with the arm placed comfortably under the head.

The skin is cleaned with betadine and alcohol and then numbed with topical anesthesia. A small needle is advanced into the lump under ultrasound guidance. As suction is applied, the needle is moved back and forth in the lump to collect an adequate sample of cells. After the needle is pulled out of the breast, the aspirated material is smeared on a glass slide. The sample is then fixed, stained and sent to pathology lab for review under the microscope by a cyto-pathologist.

At the completion of the procedure, firm pressure is given over the area of needle insertion for approximately five minutes and an adhesive bandage is placed at the entry site on the skin. No restrictions or medications are indicated following the procedure.

Results:

Results of a fine needle aspiration are usually available within 24 hours. Patient is asked to return to the primary physician for examining the breast and discuss the results.

It is important for the physician who orders for the procedure to correlate the imaging findings with the result of the cytopathologist. If the results are matching and benign, then usually nothing more needs to be done. If atypia or premalignant changes are found, a referral to a surgeon is made so that the area of involvement can be completely removed surgically. If cancer is diagnosed, an MRI and consultation with a surgical oncologist are scheduled.

If there is insufficient material for the cytopathologist to examine or if the imaging and pathology findings are not congruent, a needle biopsy or otherwise consultation with a surgeon may be recommended.

Needle Biopsy

A needle biopsy or core biopsy uses a needle alone or in combination with vacuum assistance to remove small pieces of tissue from abnormal areas in the breast. The tissue is processed so that paper-thin slices are placed on a glass slide, stained and examined under the microscope.

No special preparation is needed for this procedure and there are no restrictions following them. Patient is able to drive home and may eat and take the regular medications as usual. Antibiotic coverage is not indicated in women with mitral valve prolapse.

These are safe procedures, but possible complications include:

• Infection

• Bleeding

• Pneumothorax (collapse of a lung) – an exceedingly rare complication, particularly when imaging guidance is used for needle biopsy

Needle biopsies can be done under:

• Ultrasound guidance

• Stereotactic guidance

• MRI guidance

At the completion of any of these biopsy procedures, firm pressure is held over the area of needle insertion for about 10 minutes, after which bandages or steri-strips are used at the site of the skin incision.