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.
What is a Fine Needle Aspiration biopsy (FNA)?
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.
How is the biopsy performed?
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.
How long will the procedure take?
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.
When and how will I get my results?
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)
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.
What complications might arise?
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.
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.