A fine needle aspiration (FNA) biopsy is a medical diagnostic procedure that is used to sample fluid from abnormal lumps or masses in the body by removing a sample of cells with a hollow needle (needle biopsy). The tissue sample is sent to pathology for testing. The needle used during FNA is smaller than a needle that is normally used to draw blood.
Though other imaging tests like mammogram, ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) can reveal abnormal lumps or masses in the body, a biopsy is needed to make a diagnosis and rule out certain conditions, such as cancer. This information allows the doctor to plan the appropriate treatment.
-FNA good diagnostic accuracy in the appropriate clinical settings
-FNA is the fastest and easiest method of breast biopsy, and the results are rapidly available. FNA is excellent for confirming breast cysts, and since the procedure does not require stitches, patients are usually able to resume normal activity almost immediately after the procedure.
-Serious complications are rare, but is is a possibility. Most commonly, the patient is only left with a temporary contusion and mild discomfort.
-The procedure only removes very small samples of tissue or cells from the breast. If the sample is benign fluid (for example, a cyst), then the procedure is ideal. However, if the tissue is solid or if a sample of cloudy, suspicious-looking fluid is obtained, the small number of cells removed by FNA only allow for a cytologic (cell) diagnosis. This can be an incomplete assessment because the cells cannot be evaluated in relation to the surrounding tissue.
First, the skin of the breast is cleaned. If a breast lump can be felt, the radiologist or surgeon will guide a needle into the area of concern by palpating (feeling) the lump. If the lump cannot be felt, the FNA procedure will be done under image-guidance using either stereotactic mammography or ultrasound with the patient in either the upright or prone (face down) position. Stereotactic mammography involves using computers to pinpoint the exact location of a breast mass based on mammograms (x-rays) taken from two different angles. The computer coordinates will help the physician to guide the needle to the correct area in the breast. With ultrasound, the radiologist or surgeon will watch the needle on the ultrasound monitor to help guide it to the area of concern. FNA is usually performed under ultrasound image guidance. After the needle is placed into the breast in the region of the lesion (abnormality), a vacuum is created and multiple in and out needle motions are performed. Several needle insertions are usually required to ensure that an adequate tissue sample is taken. The samples are then smeared on a microscope slide and examined by a pathologist under the microscope. FNA does not require stitches and can usually be performed on an outpatient basis. A very small bandage is placed over the area after the procedure. Many patients resume their normal lifestyle and routine the same day of the FNA procedure.
There is no special preparation the day of the exam. However you should tell your doctor about any medications you are on. Some medications will cause excessive bleeding and should be stopped days before the procedure. It is a good idea to wear a two piece outfit, because you will need to change into a gown. Prior to FNA, the skin of the breast is cleansed and then may be anesthetized with a small hypodermic needle. Many times, the breast is not anesthetized for FNA because administering the anesthesia tends to cause more pain for the patient than the procedure itself. Also, lidocaine (an anesthesia) may cause artifacts to appear in the cytology sample when examined under the microscope.
If sedating medication is used during fine needle aspiration, you may be groggy and unable to work afterward. At the biopsy site, you may have some swelling, soreness, and pain. In most people, over-the-counter pain medicines are enough to decrease discomfort. Final results of testing after a fine needle aspiration can take up to a week or longer. Preliminary results may be available sooner.
Internal and external bleeding. Injury to nearby organs. Inadequate amount of cells removed for testing (<5%), requiring repeating the procedure. Pneumothorax in the case of lung biopsy.
What are the recommendations for travel?
In the case of fine needle aspiration/lung or abdominal biopsy with imaging, after you are discharged it is recommended that you stay at a hotel close to the hospital for at least 1 day for convenience in traveling to the hospital if any complications arise after the procedure.
What is the difference between an aspiration and a biopsy?
There are a few differences between the two. A core needle biopsy is done with a larger needle and a small incision is made in the skin above the area to be biopsied. The incision allows for easier insertion of the needle, but is not needed when performing an fine needle aspiration because the needle used is very thin.
Will the procedure hurt?
People interpret pain differently, but the FNA procedure is done using a very thin needle that should cause little or no discomfort. If you are nervous about the procedure speak to your healthcare provider and they should be able to accommodate you. After the procedure the area may be a little sore and bruised, but there are no other serious side effects.