You are on page 1of 7

Biopsy for Breast Cancer Diagnosis: Fine Needle Aspiration Biopsy

Your health care providers may refer you for a fine needle aspiration biopsy (FNA) if a lump is discovered in your breast. The FNA biopsy is used to assess the lump. In the past, this required a sometimes painful surgical procedure that involved a longer waiting period for the results. With FNA, a sample of the lump is obtained using a small, thin needle. The test often allows doctors to make a diagnosis within two to three days of the test.

How Is the Biopsy Performed?


Your doctor will ask some questions about the lump:

Where it is? How and when you first became aware of it? Have you noticed any changes in it? Next, the doctor will feel the lump. Before the actual biopsy is performed the doctor will give you an opportunity to ask any questions or express any concerns you might have about the procedure. After all your questions and concerns have been addressed, the actual procedure will begin. Holding the lump with one hand, the doctor will precisely sample the lump with a thin needle held in a needle holder, which provides greater control. Usually, two to three samples will be required from the lump to provide an accurate diagnosis. During the procedure, the doctor will usually leave the examination room with one of the slides to check that there is enough tissue to prevent the need for a second office visit.

How Long Does the Procedure Take?


Each sample takes about 10 to 20 seconds to obtain. The whole procedure from start to finish usually takes no more than 10 to 15 minutes. However, please allow an hour for your visit because of registration and possible waiting time in the office.

When Will I Get My Results?


Generally, your results should be available from your surgeon's office in two to three working days. The results can be grouped into three categories:

Clearly benign not cancer Clearly malignant cancer Non-definitive, less clear most often, this will be followed by a surgical biopsy

How Reliable Is This Test?


In the hands of a skilled FNA practitioner, this test is very reliable. In the instance of a clearly benign diagnosis, it may prevent you from undergoing surgery. In the case of a clearly malignant diagnosis, it quickly establishes the need for further treatment. In the less frequent occurrence of a non-definitive diagnosis, either repetition of the FNA or a surgical biopsy is usually recommended. Our experience at UCSF Medical Center has demonstrated a 2 percent to 3 percent chance that a cancer may not be detected. This is why you will be asked to come back for a follow-up visit. We also take into account the result of any imaging studies, such as a mammogram or ultrasound scan, and how the lump feels to your doctor. By doing this, the chance of missing a cancer is reduced to less than 1 percent.

What Complications Might Arise?


When carried out by an experienced practitioner, a fine needle aspiration biopsy is virtually free of significant complications. The most common complication is a slight bruising or tenderness of the area for a few days following the procedure. Discomfort should be relieved by an over-the-counter pain reliever such as Tylenol or the application of an icepack for short periods following your return home. Please call the Breast Care Center immediately if you experience any of the following symptoms after your biopsy:

Swelling that doesn't go away Continued bleeding A fever over 101 degree Fahrenheit (38.3 degree Celsius) Pain that is not helped by Tylenol or other non-aspirin products

Fine-needle aspiration
From Wikipedia, the free encyclopedia

"FNA" redirects here. For other uses, see FNA (disambiguation).

Fine-needle aspiration

Diagnostics

Micrograph of a needle aspiration biopsy specimen of a salivary gland showing adenoid cystic carcinoma. Pap stain.

MeSH

D044963

Fine-needle aspiration biopsy (FNAB, FNA or NAB), or fine-needle aspiration cytology (FNAC), is a diagnostic procedure used to investigate superficial (just under the skin) lumps or masses. In this technique, a thin, hollow needle is inserted into the mass forsampling of cells that, after being stained, will be examined under a microscope. There could be cytology exam of aspirate (cell specimen evaluation, FNAC) or histological (biopsy - tissue specimen evaluation, FNAB).[1] Fine-needle aspiration biopsies are very safe, minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead. In 1981, the first fine-needle aspiration biopsy in the United States was done at Maimonides Medical Center, eliminating the need for surgery and hospitalization. Today, this procedure is widely used in the diagnosis of cancer.[2]

A needle aspiration biopsy is safer and less traumatic than an open surgical biopsy, and significant complications are usually rare, depending on the body site. Common complications include bruising and soreness. There is a risk, because the biopsy is very small (only a few cells), that the problematic cells will be missed, resulting in a false negative result. There is also a risk that the cells taken will not enable a definitive diagnosis.
Contents
[hide]

1 Applications 2 Preparation 3 Procedure 4 Post-operative care and complications 5 References 6 External links

Applications[edit]
This type of sampling is performed for one of two reasons: 1. A biopsy is performed on a lump or a tissue mass when its nature is in question. 2. For known tumors, this biopsy is performed to assess the effect of treatment or to obtain tissue for special studies. When the lump can be felt, the biopsy is usually performed by a cytopathologist or a surgeon. In this case, the procedure is usually short and simple. Otherwise, it may be performed by an interventional radiologist, a doctor with training in performing such biopsies under x-ray or ultrasound guidance. In this case, the procedure may require more extensive preparation and take more time to perform. Also, fine-needle aspiration is the main method used for chorionic villus sampling,[3] as well as for many types of body fluid sampling.

Preparation[edit]
Several preparations may be necessary before this procedure.

No use of aspirin or non-steroidal anti-inflammatory medications (e.g. ibuprofen, naproxen) for one week before the procedure;

No food intake a few hours before the procedure; Routine blood tests (including clotting profile) must be completed two weeks before the biopsy;

Suspension of blood anticoagulant medications; Antibiotic prophylaxis may be instituted.

Before the procedure is started, vital signs (pulse, blood pressure, temperature, etc.) may be taken. Then, depending on the nature of the biopsy, an intravenous line may be placed. Very anxious patients may want to be given sedation through this line. For patients with less anxiety, oral medication (Valium) can be prescribed to be taken before the procedure.

Procedure[edit]

A physician's hands are seen performing a needle biopsy to determine nature of lump either fluid-filled cyst or solid tumor.

The skin above the area to be biopsied is swabbed with an antiseptic solution and draped with sterile surgical towels. The skin, underlying fat, and muscle may be numbed with a local anesthetic, although this is often not necessary with superficial masses. After locating the mass for biopsy, using x-rays or palpation, a special needle of very fine diameter is passed into the mass. The needle may be inserted and withdrawn several times. There are many reasons for this:

One needle may be used as a guide, with the other needles placed along it to achieve a more precise position.

Sometimes, several passes may be needed to obtain enough cells for the intricate tests which the cytopathologists perform.

After the needles are placed into the mass, cells are withdrawn by aspiration with a syringe and spread on a glass slide. The patient's vital signs are taken again, and the patient is removed to an observation area for about 3 to 5 hours.

For biopsies in the breast, ultrasound-guided fine needle biopsy is the most common.

Post-operative care and complications[edit]


As with any surgical procedure, complications are possible. Fortunately, major complications due to thin needle aspiration biopsies are fairly uncommon, and when complications do occur, they are generally mild. The kind and severity of complications depend on the organs from which a biopsy is taken or the organs gone through to obtain cells. After the procedure, mild analgesics are used to control post-operative pain. Aspirin or aspirin substitutes should not be taken for 48 hours after the procedure (unless aspirin is prescribed for a cardiac or neurological condition). Since sterility is maintained throughout the procedure, infection is rare. But should an infection occur, it will be treated withantibiotics. Bleeding is the most common complication of this procedure. A slight bruise may also appear. If a lung or kidney biopsy has been performed, it is very common to see a small amount of blood in sputum or urine after the procedure. Only a small amount of bleeding should occur. During the observation period after the procedure, bleeding should decrease over time. If more bleeding occurs, this will be monitored until it subsides. Rarely, major surgery will be necessary to stop the bleeding. A recent study showed that in one case a needle biopsy of a liver tumor resulted in spread of the cancer along the path of the needle, and concluded that needle aspiration was dangerous and unnecessary. The conclusions drawn from this paper were strongly criticized subsequently.[4] Other complications depend upon the body part on which the biopsy takes place:

Lung biopsies are frequently complicated by pneumothorax (collapsed lung). This complication can also accompany biopsies in the upper abdomen near the base of the lung. About one-quarter to one-half of patients having lung biopsies will develop pneumothorax. Usually, the degree of collapse is small and resolves on its own without treatment. A small percentage of patients will develop a pneumothorax serious enough to require hospitalization and placement of a chest tube for treatment. Although it is impossible to predict in whom this will occur, collapsed lungs are more frequent and more serious in patients with severe emphysema and in patients in whom the biopsy is difficult to perform.

For biopsies of the liver, bile leakages may occur, but these are quite rare. Pancreatitis (inflammation of the pancreas) may occur after biopsies in the area around the pancreas. Deaths have been reported from needle aspiration biopsies, but such outcomes are extremely rare.

References[edit]
1. ^ http://www.indepreviews.com/article/2011/vol-13-no-1/006-084-FINE-NEEDLE-ASPIRATIONCYTOLOGY-%28F-N-A-C%29.pdf 2. ^ http://www.maimonidesmed.org/Main/CultureofInnovation.aspx, First US Procedure

3. ^ Chorionic villus sampling and amniocentesis: information for you from Royal College of Obstetricians and Gynaecologists. Date published: 01/06/2006 4. ^ "bmj.com". Retrieved 2010-03-14.

Originally adapted from Preparing for a needle aspiration biopsy (634 KB). Public domain text of the National Institutes of Health Warren Magnuson Grant Clinical Center.

All about ultrasound-guided fine needle biopsy

External links[edit]

Aspiration Biopsy, Fine-Needle at the US National Library of Medicine Medical Subject Headings (MeSH)

Breast

-462749619 at GPnotebook - "fine needle aspiration cytology (breast)"

Lung

MedlinePlus Encyclopedia 003860 - "Lung needle biopsy"

Neck

ent/561 at eMedicine - "Fine-Needle Aspiration of Neck Masses" MedlinePlus Encyclopedia 003899 - "Thyroid nodule fine needle aspirate"

Bone

MedlinePlus Encyclopedia 003658 - "Bone marrow aspiration" med/2971 at eMedicine - "Bone Marrow Aspiration and Biopsy"

Fine Needle Aspiration (Fine Needle Biopsy)

Biopsy PDF, 135KB

Breast Cancer 101 (Interactive Multimedia) - Needle Biopsy Macromedia Flash

Fine needle aspiration (also known as fine needle biopsy) removes cells from a suspicious lump in the breast. The needle used is thinner than in core needle biopsy. Fine needle aspiration is only used for lumps that can be felt (palpable masses). The procedure can be done in your health care provider's office. Although core needle biopsy is most often the first choice for palpable masses, fine needle aspiration is sometimes done as a quick way to sample a breast lump felt during a clinical breast exam. Before the procedure, your provider may use a small amount of local anesthetic to numb the area. He/she will then insert the needle and remove a sample of cells. The whole procedure takes only a few minutes.

Advantages of fine needle aspiration


Fine needle aspiration is accurate when done by an experienced provider and read by an experienced cytopathologist (a physician who specializes in checking cells under a microscope). The procedure is quick and only mildly uncomfortable. Plus, there is only a small chance of infection or bruising. If the lump was not thought to be cancer before the biopsy, a benign test result means you will likely not need a surgical biopsy.

Drawbacks of fine needle aspiration


One drawback of fine needle aspiration is that the needle can miss a tumor and take a sample of normal cells instead. If this happens, the biopsy will show cancer does not exist when in fact, it does. This is called a false negative result and can delay diagnosis. When combined with a clinical breast exam and a mammogram, the false negative rate of fine needle aspirations of lumps that can be felt is about five percent [5]. Sometimes, even if the correct area is sampled, the procedure may not remove enough cells to be able to tell if they contain cancer. So, a fine needle aspiration that does not find cancer may need to be followed up with a core needle biopsy or a surgical biopsy. Another drawback of fine needle aspiration is that the cell samples give limited information about the tumor. For example, they often cannot tell whether a tumoris ductal carcinoma in situ or invasive breast cancer. The cells removed by fine needle aspiration must also be checked by an experienced breast cytopathologist, and not all hospitals have a cytopathologist. Updated 10/29/12