Dr. Leo Mahoney and my colleagues at the University of Toronto in their letter in the December issue of the Journal (Can J Surg 1998;41[6]:476–7) outlined their recommended procedure for a family doctor to deal with a breast lump.
Their advice about cysts is reasonable. Having treated 8 patients with a cancer that was in the wall of a cyst or adjacent to a cyst, I can verify that all of them were detected by dark or maroon-coloured blood on aspiration of the cyst or by the persistence of a lump after aspiration. The fluid usually aspirated from a cyst does not need to be sent for cytologic examination as they correctly observe.
However, they fail to mention that the cells from a solid lump should definitely be sent for examination. Pathologists are very accurate in confirming the diagnosis on cytologic examination. It is not good practice to stick a needle into a lump and then discard the cells. The cells in the barrel of that needle will supply a diagnosis. Anyone who aspirates a breast lump should obtain slides and pathological confirmation.