Fine Needle Aspiration (FNA)
Almost all biopsies of suspicious masses used to be open surgical
biopsies. Now more options are available. Fine needle aspiration (FNA)
biopsy is frequently used and entails placing a very thin needle inside
the mass and extracting cells for microscopic evaluation. The procedure
itself takes only seconds and the discomfort is comparable to a blood
test. In order to make FNA reliable, it is important that the sampling,
as well as the interpretation of the specimens, are done by specially
trained physicians who use the procedure frequently.
Another option is a core needle biopsy which uses a larger bore needle
that extracts a thin core of tissue. This latter procedure requires
local anesthesia and is more likely than FNA to be associated with
significant bruising of the area. Bruising may be associated with
temporary soreness in the breast but subsides gradually on it's own.
The accuracy of FNA and core biopsies is similar when carried out by
specifically trained practitioners. In large studies, two to five
breast cancers in a hundred are not identified as cancers. Because of
this limitation, biopsy results are looked at in combination with
palpation (what the mass felt like) and any image study, including
mammogram and ultrasound. This is called the Triple test. If any of the
three indicate a high degree of concern for cancer, then an open biopsy
is carried out. By using this combination method, the frequency of
missed cancers can be brought to 1% or less, which is comparable to the
miss rate when using open biopsy alone.
Question
What is a Fine Needle Aspiration biopsy (FNA)?
Answer
You have been referred for a Fine Needle Aspiration biopsy (FNA) by
your health care provider. This is because a lump was discovered and
your physician wants to determine what that lump is. In the past, the
only way to do this was to have you go to the hospital and undergo a
surgical procedure that may be painful, might cause scarring, had more
complications, and involved a longer period of anxiety while waiting
for the results. With the use of FNA, all this is unnecessary, in most
cases. We can now sample your lump using only a thin small needle which
will leave a mark no bigger than a needle stick. Furthermore, this test
will most often allow us to make a diagnosis of your lump within 1 to 2
days of the test.
Question
How is the biopsy performed?
Answer
First, the doctor will ask you some questions about the lump: where it
is, how and when you first became aware of it, and if you've 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, 2 to 3 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.
Question
How long will the procedure take?
Answer
Each sample will only take about 10 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.
Question
When and how will I get my results?
Answer
Generally, your results should be available from your surgeon or
primary care provider's office in 2 to 3 working days. The results can
be grouped into 3 categories:
1. Clearly Benign (not cancer)
2. Clearly Malignant (cancer)
3. Non-Definitive, Less Clear (most often, this will be followed by a
surgical biopsy)
Question
How reliable is this test?
Answer
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.
Question
What complications might arise?
Answer
Fine Needle Aspiration Biopsy, when carried out by an experienced
practitioner, 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 ice-pack for short periods following your return home.
IMPORTANT!
If you experience swelling that
doesn't go away, continued bleeding, a fever over 100' F, or if you
experience pain that is not helped by Tylenol or other non-aspirin
products, call your doctor's office immediately.
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