Breast cyst puncture: what it is, how the procedure and contraindications are performed


In women, cystic neoplasms are most often diagnosed in the chest and ovaries. In this case, the puncture of a cyst of the breast or ovaries is paramount and mandatory procedure. Its main goal is to exclude the presence of a malignant neoplasm. Based on the result obtained, the tactics of the future therapy will be chosen. As a rule, such a cyst is benign. However, most women are afraid of this diagnostic manipulation and try in every way to abandon it.

What is a puncture?

Before considering the method of puncturing of the breast, one should know what this diagnostic procedure is. Puncture involves puncture of soft, cartilaginous or bone tissues with subsequent collection of material for clinical, bacteriological or histological examination.

If it is necessary to take a material of a liquid consistency for analysis, the manipulation is performed with special needles, ensuring minimal traumatization of the examined and nearby organs. Puncturing for the purpose of taking a piece of tissue is performed by a special “pistol”.

The main goal of this method is to confirm or disprove a pre-established diagnosis. According to the accuracy of the result, puncture is considered one of the best. It is recommended in situations where it is impossible to identify the alleged pathology by other methods.

Quite often, patients are concerned about the issue of painlessness of this procedure. The pain during such a study is not felt. The patient will feel only the needle prick and the moment of its extraction. In some cases, a medical professional may suggest a biopsy under local anesthesia. In this case, the person being examined will feel nothing at all.

At first glance, the technique is quite simple, but it requires a specialist, conducting it, excellent knowledge of the anatomy of the human body. This medical manipulation involves a violation of the integrity of the epithelial tissues (puncture of the skin), and it must be carried out strictly in the conditions of a medical institution. That is, the risk of infection of the puncture site must be reduced to a minimum.

Any puncture is performed according to the following procedure:

  • the puncture point is selected,
  • This part of the body is treated with a medical antiseptic,
  • surface tissue is punctured, which results in access to the organs and tissues located under them,
  • sampling for examination,
  • removing the needle from the body of the person being examined.

In some cases, this procedure is performed using anesthesia, for example, this is how the kidney cyst puncture. To do this, the tissue is punctured first, through which the anesthetic is injected. Then the syringe is replaced with the subsequent collection of the studied material.

How long is the procedure for puncturing? All manipulation is carried out very quickly and takes a few minutes.

Breast cyst puncture

Breast cystic tumor is a cavity that is filled with liquid contents. Consequently, the puncture of the chest will be carried out with a special needle, not a “pistol”. The material obtained during biopsy is subjected to cytological examination. In this case, special attention is paid to the presence or absence of so-called atypical cells. That is, those cells that appear during the development of a malignant neoplasm in the human body.

Thus, the so-called diagnostic puncture is performed. There is also a manipulation carried out for therapeutic purposes. How do they differ from each other? When diagnostic puncturing is taken a small amount of fluid inside the cyst. This is sufficient for the necessary biopsy research. Therapeutic puncture provides for the complete suction of the liquid contents. As a result, the walls of the cyst collapse, and subsequently completely stick together. That is, in this way, a breast cyst is removed. A therapeutic puncture of an ovarian cyst is also conducted.

Indications and contraindications for research

This examination is carried out strictly in the direction of the attending physician. Suspect the presence of cystic neoplasm of the breast may be a surgeon or a gynecologist after a special mammological examination. It is carried out during preventive examinations of all women over the age of 40 years or upon presentation of complaints. When does the doctor refer a woman to a puncture?

  1. With palpation examination of the mammary glands is determined by the seal.
  2. As a result of diagnostic studies (ultrasound or mammography), an obscure etiology of darkened foci in the tissues is detected.
  3. Inflammatory processes in the nipple and areola with the appearance of a discharge of a different nature.

But like any medical manipulation, puncture has a number of contraindications.

  1. Pregnancy of the patient.
  2. Woman breastfeeds a baby.
  3. The presence of an allergic reaction to an analgesic drug administered during this medical procedure.

Breast biopsy technique

Before conducting the study, the patient is recommended a week before the prescribed procedure to completely abandon the use of any medications that affect the blood coagulation system.

How is breast puncture performed in cases of suspected cyst formation? Initially, an ultrasound examination or mammography is performed. They will help determine the exact location of the cyst and the depth of its location in relation to the skin. As a rule, it makes sense to prescribe a puncture at a cyst size of more than 2 cm.

For the collection of material used long and thin needle. Therefore, this medical manipulation is practically painless, therefore, does not require additional administration of anesthetic medicines. Only in rare cases, at the doctor's choice, can it be replaced with a thicker needle or a special “gun”. They are shown at large sizes of the neoplasm, while it should be freely palpable through the skin. The puncture of the cyst of the mammary glands in this case is carried out only under local anesthesia, therefore, the woman does not feel pain at all.

Sometimes, according to the testimony of a doctor, a breast cyst can be immediately removed with a therapeutic technique for taking puncture.

However, in any case, the material obtained as a result of medical manipulation must be sent for cytological examination to the laboratory.

Percutaneous puncture, as a rule, passes without serious consequences. With the observance of all the rules of asepsis, the introduction of pathogenic microflora into the place of medical examination is impossible, therefore, there are no conditions for the development of the inflammatory process.

The chest that was examined may slightly swell over the next few days. From the puncture site can be separated sukrovitsa. These are not rare, but not dangerous for women, the phenomena pass quickly enough.

Sometimes hematoma can occur. Cold compresses applied to the chest will help to get rid of it. With the appearance of pain, the use of analgesic drugs is permissible, but before that it is advisable to consult with your doctor.

In which case should a doctor seek medical help?

  1. With the emergence of severe pain.
  2. Detection of the clinical picture of the inflammatory process at the puncture site (serous or purulent discharge, swelling, redness, etc.).
  3. Temperature rise.

Timely referral to a specialist helps to quickly and painlessly determine the nature of any cystic formation using the puncture method.

(No votes) Loading.

Why spend puncture breast cysts?

One of the most common pathologies of the breast is a cyst. It is a capsule, inside which is a non-inflammatory fluid. Formations can be of different size and shape, be single or multiple, affect both one gland and both. For the diagnosis and treatment of the disease, a puncture of the breast cyst is performed.

Puncture of the cyst and its purpose

Puncture of a cyst is a medical procedure during which the formation is punctured and its contents are collected. By prescribing a similar procedure, a breast specialist usually has the following goals:

  1. Differentiation of the nature of the cells of formation, that is, the identification of malignant cells. Such a study is performed on a mandatory basis, if the doctor during the examination of the patient detects a change in skin color of the breast, ulcers, discharge from the nipples (they may be transparent, yellow or bloody).
  2. Treatment of cysts. Puncturing may have a therapeutic purpose. This method is used to combat single large formations.

The material obtained as a result of manipulation is necessarily subjected to cytological examination.

Types of cyst puncture

As already mentioned, this procedure is used for diagnostic purposes. There are several types of puncture to help identify the nature of the pathology that has arisen:

    Fine needle aspiration puncturing. Similar manipulation is performed to puncture such formations of the mammary gland that can be probed. When performing the procedure, the patient takes a sitting position, the problem area is outlined on the gland and the treatment is performed using an anesthetic. Then a thin needle is inserted into the gland tissue on the syringe, which sucks a small amount of glandular tissue.

This technique does not damage the breast tissue and does not leave a scar in the gland. The complications are minimal.

  • Stereotactic fine needle puncturing. This technique involves the sampling of tissue from different places of formation. If it is very small, the procedure is performed under the control of an ultrasound or mammography. For this, the patient lies on a special table, on which a number of shots are taken from different angles using ultrasound or mammography, which allows you to accurately determine the place for inserting the needle.
  • Thick puncture. This procedure allows the doctor to get a larger portion of tissue for study. For its implementation, a thick needle is used, having a cutting device with it. The advantage of this manipulation is the possibility of obtaining a larger tissue fragment, which contributes to a more accurate diagnosis.
  • Stereotactic puncturing. It is performed if the formation cannot be palpated and it is localized deep in the tissues. Is under the control of mammography or ultrasound.
  • Incisional puncturing. Such manipulation involves the excision of a small fragment of the tumor and is performed under local anesthesia. This procedure is carried out with doubts about the reliability of the data of aspiration biopsy.
  • Excision puncturing. This procedure is a mini-operation. It involves the excision of part of the education or the whole of it (if its size is less than 2.5 mm). If abnormal cells are found, the lymph nodes are also removed.
  • It should be noted that with aspiration and incisional procedures, false results may be obtained. The advantage of these methods in their speed.

    Preparation for puncturing

    Puncturing can be assigned only after undergoing ultrasound and mammography (sometimes pneumocystography is also required). These studies help determine the type of education, its size and shape.

    Puncture is performed if the size of the cyst exceeds 1.5-2 cm.

    Seven days before the proposed procedure, the patient should stop taking aspirin and anticoagulants, since the effect of these medicines is aimed at thinning the blood, which can increase bleeding during manipulation.

    Puncturing has a number of contraindications:

    • pregnancy,
    • breastfeeding
    • allergic reaction to painkillers.

    Puncture is prohibited in the following situations:

    • in the presence of reliable data (obtained using other diagnostic studies) on the existence of metastases in the chest,
    • in the absence of the possibility of puncturing safely,
    • if the procedure may have a negative impact on the course of further treatment of the disease.

    Cyst puncture

    Puncture, as already mentioned, can be carried out for therapeutic purposes. If the formation is large enough and it can be easily palpated, the procedure is performed by touch. If there are any problems, the puncture is performed under ultrasound control.

    To puncture a cyst, the doctor uses a special needle, which pierces the formation and evacuates all its contents. Subsequently, it is necessarily analyzed for the presence of atypical cells. If the procedure is performed with therapeutic purposes, then at the end of the manipulation, air or ozone is introduced into the cavity, which is necessary for gluing the walls of the capsule.

    Sometimes ethyl alcohol is introduced into the vacant cavity to speed up the process. This practice is dangerous, as the result of the procedure can be tissue necrosis. Then a scar remains at the site of education. It can be mistaken for a malignant formation during mammography.

    The procedure is usually performed on an outpatient basis. If a fine needle is used to take a puncture, anesthesia is usually not required. In the case of a procedure with a thick aspiration needle, the area where the puncture will be performed is anesthetized with local anesthetics (novocaine, lidocaine). This type of manipulation is chosen by the doctor in the presence of formations of large size (palpable palpation).

    Before the puncture, the specialist must perform a visual examination of the breast, paying attention to the condition of the skin (wrinkling, thickening, redness or ulceration).

    Carrying out the procedure

    Puncture or hardening is one of the main methods of dealing with a cyst.

    Despite some fear of the patients, the puncture is practically painless and completely harmless. It is carried out on an outpatient basis, if the size of the formation does not exceed 1-2 centimeters.

    1. Identify the presence of cancer cells and take the necessary measures.
    2. Eliminate the fluid remaining inside the cyst, and significantly speed up the healing process.

    You may also be interested in an article about whether a breast cyst is dangerous.

    An article on how to treat a cyst with folk remedies, read here.

    The procedure is the collection of fluid accumulated in a cyst using a puncture of a long thin needle, which pierces the skin and mammary gland. After this, the walls of the cyst are narrowed and “stick together”, which helps them dissolve faster and grow together with the gland.

    In some cases, the doctor may inject air into the place of the fluid or use a special preparation to heal faster. Before the procedure, the doctor must perform an ultrasound scan and mammography, and you can also determine if a cyst is present to the touch if it has formed close to the skin. In some cases it may be necessary to use ultrasound.

    After the puncture, the contents of the cyst are sent for analysis to identify cancer cells. The patient may persist for some time swelling or bruising, but they quickly pass. To speed up the process it is recommended to use ice. In some cases, a biopsy can be used to detect cancer at an early stage — a collection of tissue samples from several sites that are sent for analysis.


    As with any procedure, the puncture has some limitations to conduct due to serious consequences:

    • pregnancy and lactation period,
    • allergy or intolerance to available painkillers,
    • recent breast surgery,
    • high fever, viral or infectious disease, such as influenza,
    • lack of conditions for the procedure.

    According to reviews, puncture is a simple and quick way to determine the presence or absence of breast cancer, and also assists in the treatment of cysts in the early stages. After removal of accumulated fluid from a cyst, a course of hormonal and non-hormonal preparations for complete cure may be prescribed.

    What features has a procedure for puncturing a cyst of the breast, see the doctor’s comments in the following video:

    What makes the cyst appear? Are there any preventive methods? In recent times, this problem has been heard very often. Cyst of dairy veins and ovaries used to be more common in women over forty, and now and often occurs in girls of childbearing age.

    I agree that it is necessary for any woman to know about all this in order to protect herself from irreversible processes in the body. But as you read a lot of such information, you start to think out too much for yourself. It seems to me that regular visits to a gynecologist and a mammologist are the best ways to find out about your health in a timely manner.

    What is a breast biopsy

    Когда у женщины при пальпации обнаруживают в молочной железе уплотнение, ее направляют на ультразвуковое обследование (УЗИ), маммографию, магнитно-резонансную томографию (МРТ). To clarify the nature of the tumor, diagnosis, prescribe a biopsy. This diagnostic procedure is the process of collecting cells and tissues from the affected breast for histological, cytological, microscopic examination. As a result of analyzes determine:

    • the nature of the tumor is cancerous or benign,
    • degree of spread
    • stage of development
    • structure.

    Early biopsy reveals inflammatory, hormonal tumor processes in the mammary gland. The procedure helps the doctor to develop the tactics of treatment of the patient. For the collection of biomaterial using several methods. There is a special equipment, a variety of needles for carrying out manipulations. Their choice depends on the location of the tumor. In the case of deep neoplasms, the study occurs under the control of:

    • Ultrasound,
    • mammograph,
    • radiographic equipment.

    Indications and contraindications

    Breast cancer is a common pathology. Women should conduct breast self-examination monthly to identify possible changes. The indications for performing a biopsy are:

    • seals, education, revealed by palpation,
    • suspicious areas detected by ultrasound and mammography,
    • changes in obscure etiology identified by X-ray examination.

    Doctors prescribe a woman a biopsy, if the diagnosis revealed deviations from the norm. The procedure is shown in the case of:

    • appearance of ulcers on the chest,
    • bloody, mucous, purulent discharge from the nipple,
    • local skin color changes
    • violations of the tissues in the area of ​​the areola, the nipple - peeling, inhaling, crusting,
    • pathological hyperemia or paleness of the breast,
    • diseases - fibroadenomas, cysts in the breast, mastopathy, mastitis.

    There are a number of contraindications for breast biopsy. These include the inability to maintain a fixed position for an hour. Contraindications for the procedure are:

    • pregnancy,
    • intolerance to anesthetics,
    • the presence of a pacemaker
    • feverish state
    • lactation period
    • menstruation,
    • lesion size up to five millimeters.

    If a woman takes blood thinners, there is a risk of bleeding. Drugs stop using the day before the manipulation, otherwise the procedure is unacceptable. Contraindications for breast biopsy:

    • bleeding disorders,
    • the lesion near the armpit, near the chest wall,
    • severe pain in the back, shoulders, neck, diverse etiology,
    • confidence in the goodness of the tumor,
    • acute infectious diseases.

    Depending on the location of the tumor, size, stage of development, the tasks involved in the diagnosis, the method of biopsy diagnosis of tissues is selected. Breast research methods differ in performance and accuracy. Popular types:

    • Fine needle puncture - minimally invasive method, does not require anesthesia. Minus - a small amount of material for analysis.
    • Puncture thick-needle - tissue sampling is carried out through several punctures, the accuracy of the diagnosis is higher. Local anesthesia is required.

    The method of tissue sampling is selected individually. The results of studies on ultrasound, MRI, mammography are taken into account. Among the methods assigned:

    • Core biopsy - a gun is performed with a thick needle, tissue is collected along the height of the tumor. Differs in the effectiveness of diagnosis, does not leave scars, requires anesthesia.
    • Stereotactic procedure is performed by a special needle under the control of ionizing radiation mammography. It is used for difficult-to-determine, deep-seals in the chest, anesthesia is necessary.

    Mammology prescribed biopsy diagnosis of breast pathologies, taking into account the size of the seal and its location. Often used surgical method - surgery, requiring subsequent suturing. It uses:

    • incisional method - removal of part of the affected organ,
    • excisional method - complete excision of the seal with further cytological examination.

    The vacuum method of sampling the biomaterial from the breast is performed under the control of a mammogram or ultrasound. This manipulation:

    • held by a special rotating needle with vacuum suction of tissues, which are cut off with a knife,
    • in one incision, several samples are taken from the tumor sites,
    • performed with local anesthesia,
    • used to remove small neoplasms.

    Trepan-study is performed with free access to the site of the tumor. The surgeon makes an incision of the mammary gland to the neoplasm. During the:

    • the tissue is taken by a special needle with a flexible tube, through which samples are taken,
    • you can remove a cyst and then cauterize its walls with an electrocoagulator,
    • general anesthesia is required due to painful procedure.

    Preparation for the procedure

    In order for a diagnostic study to be successful, the patient must follow simple rules. Preparation for manipulation does not take much time. A woman must fulfill the requirements:

    • do not drink alcohol before
    • avoid taking anti-coagulants that inhibit blood clotting,
    • alert the doctor about the presence of a pacemaker,
    • report in the probability of pregnancy
    • notify experts about allergic reactions to drugs.

    When do breast puncture done?

    The study is shown with seals, which are determined on an ultrasound or mammography, breast deformities, as well as:

    • change the position of the nipple (inwardness),
    • change in the appearance of the skin on the chest (hyperemia, desquamation, redness),
    • discharge from the nipple, cracks and ulcers on it and / or on the areola.

    Puncture of the mammary gland is indicated for the differentiation of detected neoplasms (benign from malignant), making an accurate diagnosis and selecting adequate therapy. In some cases, cysts (fluid suction) are treated simultaneously with tissue sampling.

    How to do breast puncture?

    The study does not require special training. A woman should not take several days before and after puncture anticoagulants (drugs against blood clots). For other medications you need to talk with your doctor.

    Puncture is performed without anesthesia, especially if the tumor lies close to the skin surface. If the seal is localized in the deep layers of the breast, local anesthesia is possible.

    Puncture of the mammary gland is carried out using a conventional syringe (surface) or a special pistol. The introduction of forceps is also possible. Outwardly, they are no different from a needle, but in the hands of the doctor, the tips split and “bite off” a tiny piece of pathological tissue. Usually it is enough for histological analysis.

    Under the control of ultrasound

    Any puncture of the breast is carried out under ultrasound guidance. The exception is neoplasms that are close to the skin and are easily palpable. The technique of conducting requires the simultaneous presence in the diagnostic room of two specialists - an oncologist and a sonologist.

    The uzist doctor, who scans the mammary gland with an ultrasound scanner sensor, monitors the needle advancement on the monitor screen and makes corrections if necessary. An oncologist makes a puncture directly. He also sends punctate to histology.

    Breast cyst puncture

    It is performed under local anesthesia. The deeper in the chest is a cyst, the harder it is to get to it. The study is carried out under the control of ultrasound. With the deep occurrence of a tumor, a special pistol and needles of larger diameter are used.

    The doctor acts in the following sequence:

    1. Treats puncture site on the chest with an antiseptic.
    2. Introduces the needle and slowly moves to the tumor, watching their actions on the monitor.
    3. Produces a collection of cyst contents.
    4. Once the syringe is full, remove the needle from the chest.
    5. If the cyst is not completely empty, the doctor repeats his actions again.
    6. The needle penetration site is again treated with an antiseptic, a patch is applied on top.

    When the fluid is completely removed, the walls of the cyst collapse, and the tumor in the breast ceases to exist. This method of treatment is considered optimal due to low invasiveness. Psychologically, the procedure is much easier for women to tolerate than full surgical intervention.

    Breast fibroadenoma puncture

    This neoplasm is benign. It occurs in the mammary glands in women of reproductive age (up to 35 years). The basis of fibroadenoma is glandular tissue. The cause is a complication of mastopathy. The size of the tumor - 0.2 - 15 mm. Under the skin is mobile, does not have a permanent location, the edges are smooth.

    It is believed that breast fibroadenoma never degenerates into cancer, but this view is erroneous. Tumors larger than 2 cm are surgically removed. Up to this point, the tumor is observed. Puncture is necessary to clarify the diagnosis.

    The study is carried out under the control of ultrasound. With the help of a needle, the pathological tissue is taken and sent for histology.

    Effects of the procedure

    After the puncture, the patient may experience slight bleeding in the area where the puncture was made. If there are painful sensations, pain medication is indicated (excluding those containing aspirin). Locally, it is recommended to apply pieces of ice to the affected area to reduce puffiness and reduce discomfort.

    Usually the recovery period takes two to three days. Complications during puncture (infection) are extremely rare and solely due to the use of non-sterile instruments during manipulation.

    Puncture of the mammary gland is completely safe for patients, as it is carried out under the control of ultrasound or mammography. This procedure helps the doctor accurately diagnose the nature of education. In some cases, it is indispensable (with the appearance in the chest painless seals, changes in the skin of the gland, discharge from the ducts). Every patient should remember that the main thing in any illness is to make the right diagnosis and start fighting the disease in time. Also, such manipulation effectively enough helps to cope with single large formations in the mammary glands.

    The essence of the procedure

    By the procedure of puncturing a cyst is meant medical manipulation, which is a puncture of an abnormal formation, followed by drawing out of its liquid contents.

    This procedure is prescribed mammologist. It is necessary for:

    • Determining the nature of the cells of the pathological formation, in other words, identifying their malignant form. Such a study is mandatory to use, in those cases, if there is a change in the color of the skin of the breast or if different secretions occur from the nipples,
    • Treatment of cysts. Such a procedure can be used as a therapeutic treatment. However, it can only be used to eliminate single large formations.

    Types of puncture

    The main scope of such a procedure is a puncture biopsy of the mammary gland, that is, the conduct of diagnostic measures. Based on this, it is divided into several types of such a procedure, which allow to identify the parameters of the pathology:

    • Fine needle aspiration puncturing. This type of procedure is performed on those anomalies that can be felt with palpation. The essence of the procedure is to first outline the problem area, then treat it with an anesthetic. Next, enter a thin corner in the gland located on the syringe, then pump out a certain amount of fluid,

    Worth knowing! This technique is minimally invasive and leaves no scars.

    • Stereotactic fine needle puncturing. This kind of technique consists in taking already images of tissue pathology from its different parts. When this formation is small, the procedure is monitored by ultrasound,
    • Thick puncture. A similar procedure is used to obtain a region of tissue of considerable size that is necessary for a more complete study and, accordingly, a more accurate diagnosis. To do this, use a thick needle with a cutting device,
    • Stereotactic puncturing. It is carried out in cases where the pathology cannot be palpated due to its deep location in the tissues,
    • Incisional puncturing. This procedure is the excision of part of the tumor, which is carried out under local anesthetics. She is prescribed when there is doubt that an aspiration biopsy has produced the right results,
    • Excision puncturing. This type of procedure is considered a small operation. During it, the excision of a part, or of the whole pathology, whose size is less than 2.5 mm, is carried out. And in case of detection of atypical cells, it is necessary to carry out the removal of lymph nodes.
    Stereotactic fine-needle puncturing

    Important! Aspiration as well as incisional procedures do not always provide accurate information. Therefore, it is recommended to carry out the puncture.


    As already stated above, such a procedure can be carried out as a therapeutic measure. In the case when the pathology can be felt with your own hands, then the puncture is also performed by touch. If there are any problems, then the procedure is carried out under the control of ultrasound.

    During the puncture, a special needle is used, with the help of which the pathology is punctured and the contents are drawn through it. Then he is sent for analyzes to conduct a test for the presence of atypical cells in the fluid or in other words cancerous.

    When the procedure is carried out for the treatment of education, after the contents are evacuated from it, ozone is pumped into it, which leads to the adhesion of the walls. In some cases, ethyl alcohol may be injected there, although such a procedure is dangerous due to the chance of tissue necrosis.

    A similar procedure is carried out on an outpatient basis. In the case of the use of fine-needle method, the use of anesthetic is not required. And if a thick aspiration needle is used for this, local anesthesia is performed.

    The latter option is used when there are large pathologies. At the same time, before the start of the procedure itself, the doctor must necessarily conduct a full visual examination of the breast. His attention should be focused on the detection of various skin defects, from wrinkling and compaction, to redness. Read more on removing a breast cyst.

    Possible consequences

    When the puncture is completed, the patient may experience a small amount of blood in the place where the needle was inserted. If strong or moderate painful sensations are present, the use of painkillers is prescribed (except for aspirin). At the place where the puncture was, for the first time a small piece of ice is applied, which allows to reduce puffiness and also reduce the pain that is present.

    Often, rehabilitation takes only a few days. In this case, complications are possible only if, during the intervention, non-sterile instruments were used by the doctor.

    Such a procedure is very safe for patients, due to the fact that it is carried out under the control of ultrasound. This kind of procedure allows the attending physician to make an accurate diagnosis, as well as to identify the breed of pathology. Here, each patient must understand that in order to prescribe the correct treatment, it is also necessary to have the correct diagnosis. This is the key to correct treatment. Among other things, such a manipulation rather well eliminates large single anomalies that develop in the mammary glands.

    Have you ever suffered from problems with cysts? Judging by the fact that you are currently reading this text - the problems still bother you. And you know well what is:

    • Intense, sudden pain
    • Pain due to physical exertion
    • Bad and restless sleep
    • New sores that do not allow to live in peace

    Perhaps it is more correct to treat not the effect, but the cause? How to do it as effectively as possible tells the chief gynecologist of Russia.

    Breast cyst puncture: indications, results

    Some women who have heard from their doctor that they need a puncture of a breast cyst are terrified. After all, in essence, this means piercing the breast with a syringe and pumping out pathological fluid from it. In fact, everything is not as scary and painful as it seems. In addition, sometimes only a puncture allows you to equalize the course of treatment, directing the process in a positive direction.

    What is a breast cyst

    A cyst is a pathological formation that is a shell with a liquid (or fat) inside. Cysts are different: they are single and multiple, benign and malignant. To determine the nature of cysts allows mammography and biopsy.

    In the mammary glands cysts are formed due to the expansion of the ducts. The glandular secret clogs them and accumulates in small formations. If cysts grow and grow in size, the woman can feel this. You need to palpate your chest: tight balls will be easily felt. Less commonly, cysts are visually inspected. Когда образования очень крупные, приходится делать пунктирование с целью избавить женщину от боли и дискомфорта.

    Как проводится пункция

    Биопсия молочной железы делается только в амбулаторных условиях. It should be carried out by an expert who knows the structural features of the female breast (breast specialist, surgeon). Puncturing involves puncture of the skin and further penetration of the medical needle through the tissues, so the procedure is performed under sterile conditions (so as not to infect the infection).

    The algorithm of actions is approximately as follows:

    1. The doctor chooses a puncture point.
    2. The selected area is treated with an antiseptic (if the breast is small, then it is treated completely).
    3. Puncture is made.
    4. The content of cysts is taken for biopsy.
    5. The needle is removed from the breast.
    6. The puncture site is re-treated with an antiseptic, and a bactericidal patch is applied to it.

    Punctuation is preferably carried out from 6 to 14 days of the cycle. During this period, the breast is softer and supple. It is not yet subject to monthly changes, so it is not increased and does not hurt before menstruation. Therefore, the doctor will ask the patient about the cycle and will try to offer her the procedure on certain days. For women who already have menopause, biopsy tests are taken on any given day.

    Does puncture hurt?

    The chest is the most sensitive place, so women are also worried about sensations during the biopsy. But anesthesia is usually not required, because the needle for puncture of the breast is very thin.

    According to the patient reviews, it is not so much painful to do a puncture. The woman realizes that now they will pierce her breasts, and then suck the contents out of her, and psychologically it is very difficult for her to accept. But after the first puncture all fears pass.

    Biopsy results

    The main thing that a woman wants to know from the results of her biopsy is the nature of cysts. If they are benign, the patient sighs with relief. For the doctor, other information is also important:

    • the size of the formations
    • their number and localization,
    • the consistency of the content, its color, the presence of blood.

    All these parameters will help the doctor determine the further treatment strategy and prevent the development of a cyst in breast cancer. The patient is prescribed medication, prescribed vitamins, she will have to be monitored regularly by a mammologist, etc.

    The waiting time for the biopsy results is minimized, since it is clear that the woman will be very excited. Usually the patient is asked to come on the third day, that is, if the analysis is taken on Monday, then his results will be ready by Thursday. In force majeure cases when the suspicion of oncology is high, an express biopsy is indicated.

    Types of research

    Different types of breast biopsy are used to obtain the material:

    • fine-needle aspiration - used to obtain a suspension of cells with their subsequent cytological examination,
    • core biopsy with a larger needle using a biopsy gun or a vacuum biopsy system (such methods allow you to get a "column" of tissue and examine their histological structure).

    Advantages over excision biopsy

    An excision biopsy involves the surgeon using a scalpel to remove a suspicious area of ​​breast tissue. Compared with this method, diagnostic puncture has several advantages:

    • there is no need to visit the surgeon before the intervention and for the control examination, thus, the time required for diagnosis is reduced,
    • since up to 80% of biopsies are performed on benign breast processes, the removal of a larger volume of tissue is impractical and can lead to its deformation,
    • scars formed after a surgical (excisional) biopsy may later be mistaken for pathological lesions on a mammogram and will result in the need to re-examine,
    • the study of material obtained by surgery takes more time, which causes additional stress in the patient,
    • research cost is about 2 times lower
    • puncture of fibroadenoma of the mammary gland or other benign lesion often makes it possible to avoid surgical intervention.

    What are the size of the tumor puncture of the breast?

    As soon as education becomes noticeable on a mammogram or an ultrasound scan, it is already possible to resolve the issue of manipulation. The cyst is usually punctured when its size is from 1 to 1.5 cm.

    Can a puncture trigger cancer?

    No, it cannot, the mechanical removal of a part of the tissue does not lead to a malignant degeneration of the surrounding cells. If the needle got into a malignant tumor, then there is a minimal likelihood that the cancer cells will “stretch” after it. Clinically, it does not matter.

    What does this analysis show?

    It is prescribed for suspected cysts, benign tumors or malignant neoplasms and is necessary to determine the tactics of treatment and the amount of necessary surgical intervention.

    Taking a puncture of the breast


    • the presence in the gland tissue of the formation detected by mammography or ultrasound,
    • multiple lesions,
    • violation of the internal structure of the body
    • detection of microcalcifications,
    • discharge from the nipple outside the lactation period,
    • deformation of the nipple area or the surface of the skin of the organ.

    Volume gland formation

    Any volumetric focus in women over 25 requires a biopsy. If, in this case, calcified fibroadenoma, lipoma, fat necrosis or scar after surgery is detected, no further diagnosis is indicated.

    • in younger women, if an ultrasound detected a lesion without obvious signs confirming its goodness,
    • in cases where a suspicious formation is seen on a mammogram, and it is not detected on an ultrasound.

    Violation of the structure of the body

    Distortion of the normal structure of the ducts and glandular tissue may be the first signs of cancer. They are associated with a malignant process in 10-40% of cases. Many of these disorders are poorly visible with ultrasound, and therefore require puncture under x-ray control. If cells with atypia are obtained as a result, a surgical biopsy is then required. When structural disorders to assess the condition of the gland requires at least 10 tissue samples.


    These are small areas of calcified tissue, which have a very high density on the mammogram and stand out clearly against the background of the surrounding structures. All of them require research under x-ray control, but a fine-needle biopsy is not indicated in this case. Vacuum aspiration may be applied with suction of the suspect area.

    Cyst aspiration

    To remove simple cysts that cause discomfort in the patient, a fine-needle puncture is shown under ultrasound control. Asymptomatic cysts do not require removal, unless they are accompanied by pathological ultrasound signs.

    These features include:

    • thickened wall or internal partitions,
    • near-wall deposits,
    • heterogeneous internal structure,
    • no amplification of acoustic shade.

    Vacuum biopsy system for breast core biopsy

    How to prepare?

    If the patient is taking anticoagulants or antiplatelet agents, such as Aspirin or Warfarin, it may be necessary to gradually reduce the dose in advance and then cancel it for a while. Prior to this, it is necessary to consult with the specialist who prescribed the medicine and pass a blood clotting test (coagulogram).

    It is undesirable to carry out manipulation in the first 5 days of the cycle (during menstruation). It is necessary to wash and dry the mammary glands, remove the jewelry. There is no need to follow a special diet, you can have breakfast in the morning.

    Puncture equipment and its types

    The choice of research method depends on the equipment available in the hospital.

    Stereotactic puncture (core biopsy)

    The device works on the principle of triangulation. The location of the lesion is determined using a series of X-rays taken at different angles. Next, the exact position of the formation is calculated by computer processing, and the biopsy device, under X-ray control, is placed at the desired point on the skin.

    During the procedure, the patient can be in two positions:

    • lying on his stomach, with his chest dipped in a special hole on the x-ray table,
    • sitting like during a mammogram.

    The position is chosen depending on the location of the tumor and the physical capabilities of the patient.

    Fine needle puncture

    The procedure is performed with a thin needle of small diameter, which is less painful and more secure, especially for women with impaired blood coagulation. The main disadvantages are lower diagnostic accuracy. Erroneous conclusions about the absence of cancer are found in 1-30% of cases. On the other hand, with a fine-needle biopsy of a fibroadenoma or lipoma, the result may be false-positive. Breast cyst puncture is used when it is detected on a mammogram or an ultrasound scan of a cavity filled with liquid contents.

    The patient is in a supine position with her arms raised or on her side, and her arms are pulled behind her head.

    In any case, if there is a discrepancy between the research data and mammography, a cor-biopsy or surgical intervention is required.

    How to take a breast puncture?

    The procedure is performed without anesthesia, less often requires the introduction of a small amount of anesthetic drug into the tissue or superficial anesthesia with an anesthetic cream. The puncture is performed either by a single doctor, or an assistant helps him, for example, to conduct an ultrasound control.

    The puncture site is limited to sterile wipes, the skin is disinfected, and a needle attached to a syringe 10-20 ml is injected, or a biopsy device is used. With stereotactic biopsy, this entire process takes place while X-rays are scanned at the same time, and if the breast is punctured under ultrasound, the doctor applies a sensor to indicate the passage of a needle. The number of punctures depends on the goal, the number and size of lesions. Doctors try to do as few punctures as possible to reduce the likelihood of complications.

    After the procedure, the puncture site is treated with alcohol, a sterile gauze pad is applied. After 2-3 days, the hole after the puncture completely heals. Up to this point, it is desirable to constantly wear a supporting bra, you can make cooling compresses.

    Possible complications

    Is breast puncture dangerous?

    Serious complications after a cor-biopsy are observed only in 2 women out of 1000. These include hematomas (hemorrhages in the tissue) and inflammation. In extremely rare cases, bleeding from the puncture site is possible. Approximately 5% of patients experience dizziness and fainting, which are quickly resolved.

    Lighter consequences of breast puncture develop in 30-50% of patients:

    • pain that lasts up to 2 weeks after the procedure,
    • noticeable bruise on the skin,
    • emotional stress.

    In the case when after the puncture there is pain in the mammary gland, the use of conventional painkillers is acceptable. If these feelings persist for more than 2 weeks, you should consult a doctor.

    There is a single observation of a complication in which, during a coronary biopsy, a lactic fistula formed in a nursing woman, which healed within 2 weeks. Also described is the case of a large hematoma in a patient with a coagulation disorder. Such a hemorrhage "masked" the area of ​​the biopsy in which the cancer was diagnosed. After 3 months, the hematoma resolved, and an opportunity to have an operation appeared. Cases of a puncture of a chest wall with formation of pneumothorax - in 1 of 10 thousand supervision are also described.

    Does the puncture of the breast hurt?

    A biopsy with a thin needle causes almost no discomfort or any complications. For cor-biopsy, local anesthesia can be used.

    The diagnostic value of the study

    The accuracy of the results depends on the accuracy of the manipulation, careful histological analysis and their coincidence with the results of mammography or ultrasound.

    Probability of accurate diagnosis in case of cor-biopsy:

    Why is re-puncture prescribed?

    The problem is the incompatibility of the results of biopsy and mammography. If during radiography there is every reason to suspect a malignant tumor, and the puncture gives a "benign" result, it is necessary either to repeat a coropsy, or to perform a surgical intervention. If the results do not match in 47% of cases, the patients end up with a malignant tumor.

    In addition, there are cases when cancer cells and benign lesions accompany the lesion focus. Sometimes in the analysis revealed only benign component. Therefore, there are risk groups that need either regular puncture or surgical biopsy:

    • atypical ductal hyperplasia or ductal atypia, which is often adjacent to or reborn into a malignant tumor,
    • radial scars in the gland tissue,
    • fibroepithelial neoplasms, when differential diagnosis between fibroadenoma and a leaf-shaped tumor is difficult,
    • in situ lobular carcinoma,
    • cases when after the puncture of the mammary gland the size of the tumor has increased.

    Decoding results

    Normal breast tissue contains:

    • connective tissue cells and fibers
    • fat slices,
    • epithelium lining the milky ducts.

    Adipose tissue prevails over the connective, atypical (i.e., potentially malignant) cells are absent. The norm in the conclusion of a cor-biopsy excludes any disease by 97%.

    In benign processes, the pathologist will find in the biopsy a large amount of connective tissue, epithelium with degenerative changes, other cells that are not typical for a normal picture. However, he can give an opinion on the possible presence of such diseases:

    • cystic fibroadenomatosis (what was formerly called diffuse mastopathy),
    • fibroadenoma (benign tumor),
    • intraductal papilloma (similar to a polyp in the duct),
    • fat necrosis
    • ductectasis, plasmacytic mastitis (dilation of ducts).

    When a cyst is punctured, the color of the received content is also evaluated. If the biopsy tissue color is normally pink, then cyst is characterized by white, bloody, or even green fluid. If you suspect the development of an infectious process, you can sow the resulting contents and identify the suppuration microorganisms.

    The presence of red blood cells in the puncture of the breast are not a sign of a malignant tumor. They can get into the material if the vessel is damaged or, for example, the wall of a cyst or adenoma.

    If atypical cells, cells with signs of malignancy are found in the sample, then the pathologist may suggest the following diagnosis:

    • adenocarcinoma,
    • cystosarcoma,
    • intraductal carcinoma,
    • infiltrative cancer,
    • medullary cancer,
    • colloid cancer,
    • lobular carcinoma,
    • sarcoma,
    • Paget's disease.

    If a breast cancer is suspected, its tissue is examined for the presence of estrogen receptors (ER) and progesterone receptors (PR). This is important for determining further treatment tactics.

    How much to wait for the result?

    It all depends on its complexity and type of manipulation. It usually takes 3 to 5 days. In the study of ER and PR, as well as BRCA testing, the analysis can take from 7 to 10 days.

    Deciphering the results is carried out by a breast specialist, taking into account all other data. You should not independently interpret the obtained conclusion.

    Treatment of mastitis with a puncture

    Sometimes puncturing is performed not for the purpose of taking tissues for analysis, but simply for pumping out pathological fluid. So, the puncture is assigned to women with solitary or purulent cysts in the mammary glands. The procedure is also performed on an outpatient basis by a breast specialist.

    The contents of cysts, obtained by puncturing, has a yellowish or gray color. If the fluid is green or dark brown, then the cyst is running. In this case, biopsy is also sometimes done to exclude inflammatory or oncological processes.

    By the way! If the cyst is too small and poorly palpable, then the puncture is performed under ultrasound control. It is necessary that the needle immediately fell exactly into the cyst, and there were no unnecessary punctures.

    Puncture of the breast site

    No different from a similar study on breast cyst or fibroadenoma. Is under the control of ultrasound, if the node lies deep. When localized close to the skin surface, palpation is sufficient for precise needle insertion. In this case, applied fine needle puncture. When collecting material from the deep layers of the breast, thick needles are used.

    What to do before and after the biopsy

    There are recommendations that will help reduce discomfort during and after puncture of the breast cyst, as well as prevent complications:

    1. For a couple of days you should not take blood-thinning drugs (aspirin, heparin, warfarin).
    2. Do not drink alcohol for 3 days.

    During the procedure itself, you need to behave calmly and fulfill all the requirements of a specialist. Do not make sudden movements, otherwise the doctor may miss, and will have to make a new puncture.

    There are no scars after the puncture. If a hematoma appears, but it passes quickly enough. При появлении сильных болезненных ощущений после биопсии нужно сообщить об этом врачу. Он назначит специальные анестетики.

    Анализ и расшифровка результатов пункции молочной железы

    Собранный пунктат наносится на стерильные предметные стёкла и отправляется в лабораторию. Here it is studied under a microscope, and the doctor "makes a verdict." In approximately 85% of cases, the tumor in the mammary gland is benign.

    The decoding indicates the presence or absence of atypical cells. The terminology is as follows:

    1. Norm - tissue sample is clean, atypical cells are not detected.
    2. Incomplete - the analysis did not work. The probable cause is an insufficient amount of material for research in punctate.
    3. Non-cancer - atypical cells are found in the sample, but this is not a tumor. This result is obtained when a woman is diagnosed with mastitis or mastitis.
    4. Malignant - the presence of atypical cells is confirmed.
    5. Benign - cells in a sample of material randomly divide, but do not lose touch with the tissues from which they originated (differentiation).

    Difference of a puncture from a biopsy

    Immediately it should be noted that the puncture is nothing but a type of biopsy. With such procedures, an incision (puncture) of the gland tissue is performed.

    The main distinctive features are that during puncture (puncture), the material is taken. As for the biopsy, it implies a diagnostic method. In other words, biopsy is a broader concept of this method of examination.

    The main types of breast puncture

    In medical practice there are several types. The first view is called fine needle aspiration procedure. During the examination, doctors perform cell sampling, after which the resulting material is sent for cytological diagnostic examination.

    The second type is called core biopsyIn this case, a needle is used in the course of this method of examination (the diameter of the needle itself is small). The procedure is performed using a special biopsy gun, less often a vacuum system is used. With this method, you can quickly get a "column" of tissue. Then the material is carefully studied: the histological structure is examined.

    What sizes of cysts can I puncture?

    Not at all sizes you can carry out this procedure. For cysts in the mammary gland, the doctor, before sending the woman to the puncture, prescribes an ultrasound examination or mammography. If the cystic formation varies from 1 to 1.5 cm in diameter, then puncture can be performed.

    Can the procedure provoke cancer?

    This question worries many patients. In fact, the puncture cannot cause cancer in a woman. Often the puncture is carried out with cystic formations that occur with a malignant process. Even if, during the procedure, the needle penetrates the malignant cyst, the cancer cells will simply “stretch” after it. Therefore, we can conclude that the procedure does not lead to a malignant course and, moreover, does not affect the surrounding tissues even after the puncture of a cancer cell.

    Now you know the main indications of puncture in cystic formations in the mammary gland. Remember, as soon as the first signs of discomfort appear in the chest area, you should immediately consult a doctor. The sooner the problem is identified and the necessary treatment measures are taken, the greater the chances of avoiding serious complications.


    Many people ask, can there be complications after a puncture? Yes, but it should be noted that serious complications are extremely rare. According to statistics, it was noted that complications after puncture are extremely rare.

    What can arise? After puncture, a hematoma may form, in other words - a hemorrhage in the tissue. In addition, after the diagnostic method, the patient may develop an inflammatory process.

    In rare cases, bleeding occurs after the procedure, directly at the puncture site.

    In 5% of women, dizziness may occur after puncture, up to fainting. Such signs pass by themselves, the main cause of development is stress, fear of a puncture.

    In 30-50% of women, after a puncture there is pain, which can last for 1-2 weeks. In this case, you must immediately contact the doctor, prescribed anesthetic light drugs.

    Lactic fistulas may occur in lactating women, after the examination, in particular coronary biopsy, they disappear within 14 days.

    How do puncture cyst breast

    Unlike other methods of examination for cystic lesions in the chest, prior anesthesia is not required. If the pain threshold is sensitive, then a small dose of anesthetic drug is administered to the woman in the puncture zone or an anesthetic cream is applied to the breast area.

    Most often, Lidocaine or Novocain are used as local anesthesia. The first drug contains lidocaine hydrochloride monohydrate, therefore the drug suppresses not only pain impulses, but also other modality impulses.

    The second drug contains procain - the main component of the drug. Novocain demonstrates moderate anesthetic activity. The main purpose of the drug is to prevent the generation of pulses, and their further conduct, directly along the nerve fibers.

    Stages of the procedure

    1. The puncture room of a nurse or doctor is limited, for this purpose sterile wipes are used.
    2. Conducted thorough disinfection of the skin.
    3. A thin needle is inserted which joins the syringe (the volume of the syringe can be from 10 to 20 ml). If necessary, a biopsy device is used for the procedure.
    4. If stereotactic biopsy is performed, an additional scan is performed, directly by X-rays.
    5. If this procedure takes place under the control of an ultrasound machine, then a sensor is additionally superimposed on the chest area, which will help to show the passage of the needle.
    6. The number of punctures varies, depending on the degree of damage and the location of the formations. Doctors try to make fewer punctures, it helps to avoid further complications.
    7. After taking the material, the site is carefully processed. To do this, doctors use alcohol or another antiseptic solution. The final stage is the imposition of a sterile wipe.

    Within a few days, the puncture site disappears. Doctors strongly recommend not wearing a pressing bra for 3 days after the procedure.

    The advantages of puncture before excisional biopsy

    Before answering the main question, each patient should know that with an excisional method of examination, the surgeon removes a specific tissue area. Therefore, puncture compared with this method has a number of significant advantages.

    1. The patient does not need to visit the surgeon before the procedure. Therefore, the time for diagnosis is significantly reduced.
    2. A biopsy is performed, as a rule, if the patient has a benign process in the breast. If in this case an excisional biopsy is used, then this can lead to a gland deformity.
    3. After the excision procedure, large scars remain.
    4. Material that is surgically obtained is examined longer.

    As you can see, the benefits of puncture are many. But, in addition, it should be noted that the cost of puncture is several times less compared to the excision procedure.

    Breast cyst treatment

    For effective treatment, a woman needs to undergo this procedure. The main objective of the puncture is to identify all violations. Against the background of the findings, doctors select appropriate treatment methods.

    1. Prescribe medications to restore the natural balance of hormones.
    2. In case of simple cystic formations, doctors inject into the cavity with a puncture a liquid that will help to obliterate the formation.
    3. In case of multiple cystic formations, conservative therapy is prescribed, which includes taking anti-inflammatory and resolving drugs.
    4. If the cyst does not exceed 15 millimeters in diameter, then it is sucked off using a puncture needle. Then drugs are introduced that glue the walls together, this avoids a relapse.
    5. For complicated cysts (suspected cancer), surgery is performed.
    6. If necessary, doctors can prescribe traditional methods of treatment that will help dissolve cystic education.

    Additional methods are assigned depending on the type of education and related problems.

    The puncture is carried out not only as a diagnosis, it can also be used for the treatment of cystic education. But, in order to carry out treatment in time and avoid complications, it is necessary to consult a doctor at the first uncomfortable signs.

    Reviews after the passage of the puncture of the breast

    Breast puncture is an opportunity to confirm or refute a preliminary diagnosis. For many women, it becomes a lifeline. When they find out the results of histology - the cancer is not confirmed, they are ready to undergo such a procedure every time the doctor asks about its necessity. And this is despite the fact that for the first time they were categorically opposed.

    Here are just a few reviews about breast puncture:

    Tamara, 33 years old
    “I didn’t have any health problems, and I never complained about chest pains. After the first pregnancy, about a year later, she found a very small induration in the breast, on the right. I went to the doctor, they did an ultrasound scan on me and said that we would observe - presumably, mastopathy in the initial stage. A year later, I became pregnant. The “ball” in my chest disappeared, and I forgot about him. And about a year ago, in another breast, during self-examination, I found a strange thing. She constantly changed location, was not sick at all, and when she felt out, she seemed to be of something perfectly regular shape. An ultrasound scan suggested breast fibroadenomas and sent for puncture. She was terrified. But the doctor got good - he explained everything, reassured. Did under the control of ultrasound. It does not hurt at all. And after the puncture, there was no pain either. I just stuck a needle hole with a plaster and sent it home. On histology, the diagnosis was confirmed. So don't be afraid, it doesn't hurt at all. ”
    Natalia, 29 years old
    “While probing the chest, I found some kind of compaction. The doctor said that you need to do an ultrasound. But somehow there was no time. I got bogged down at work and even forgot about my “little thing”. She remembered only when, while lying on her stomach, she began to make herself felt (it was painful). I went to the doctor again, then on the ultrasound. They said that the cyst and need to do puncture. It seems like even from her during the procedure immediately and relieve. I really didn't want to be poked at me with a needle, but I had to. In fact, they pumped fluid from the breast and that's it. It does not hurt a bit, and the hospital did not have to go. "
    “My daughter, at the age of 23, had some kind of compaction under his chest. It did not hurt, it was soft. I immediately go to the gynecologist, she is on her ultrasound. And immediately diagnosed - cancer. True, they said it was inaccurate. Like, make a puncture of the breast. My daughter flatly refused to go for such an examination, she was hardly persuaded. It turned out that this is fatty necrosis of the mammary gland and it looks like an ultrasound scan, it really looks like cancer. That’s how the puncture helped us calm down. ”

    The study of tumors of the mammary glands with the help of sampling punctate most informative and allows you to accurately make a diagnosis. Most women refuse to do a puncture, arguing that "I do not need to prick with needles." However, those who have gone through the procedure have a different opinion. If any of you, readers, made a puncture of the breast, share your impressions. Did you have any complications, pain, how justified was the preliminary diagnosis?