Fine-needle aspirationfine-needle aspiration biopsy, fine-needle aspiration
Fine-needle aspiration FNA is a diagnostic procedure used to investigate lumps or masses In this technique, a thin 23-25 gauge, hollow needle is inserted into the mass for sampling of cells that, after being stained, will be examined under a microscope biopsy The sampling and biopsy considered together are called fine-needle aspiration biopsy FNAB or fine-needle aspiration cytology FNAC the latter to emphasize that any aspiration biopsy involves cytopathology not histopathology 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,1 eliminating the need for surgery and hospitalization Today, this procedure is widely used in the diagnosis of cancer and inflammatory conditions
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
- 1 Medication uses
- 2 Preparation
- 3 Procedure
- 4 Post-operative care and complications
- 5 Criticism
- 6 See also
- 7 References
- 8 External links
This type of sampling is performed for one of two reasons:
- A biopsy is performed on a lump or a tissue mass when its nature is in question
- 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,2 as well as for many types of body fluid sampling
It is also used for ultrasound-guided aspiration of breast abscess,3 of breast cysts, and of seromas4
Several preparations may be necessary before this procedure
- No use of aspirin or non-steroidal anti-inflammatory medications eg 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
ProcedureeditA 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 commonThe biopsy is advised
Post-operative care and complicationseditFNA of pancreatic tissue An adenocarcinoma is seen on the left, normal ductal epithelium on the right
As with any surgical procedure, complications are possible, but 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 with antibiotics 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
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
- In biopsies in the area of the breast, bleeding and bruising may occur, less frequently also infection rarely or very rarely, and only if performed near the chest wall pneumothorax
- Deaths have been reported from needle aspiration biopsies, but such outcomes are extremely rare
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 subsequently5
- Antibody barcoding, a technique for identifying proteins in small tissue samples such as aspirates
- ^ http://wwwmaimonidesmedorg/Main/CultureofInnovationaspx, First US Procedure
- ^ Chorionic villus sampling and amniocentesis: information for you from Royal College of Obstetricians and Gynaecologists Date published: 01/06/2006
- ^ Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L October 2011 "Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up" Radiographics : a Review Publication of the Radiological Society of North America, Inc review 31 6: 1683–99 PMID 21997989 doi:101148/rg316115521
- ^ Department of Pathology University of Massachusetts Medical School Emeritus Guido Majno Professor; Department of Pathology University of Massachusetts Medical School Emerita Isabelle Joris Associate Professor 12 August 2004 Cells, Tissues, and Disease : Principles of General Pathology: Principles of General Pathology Oxford University Press p 435 ISBN 978-0-19-974892-1
- ^ "bmjcom" 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
- Video showing ultrasound-guided fine needle biopsy
- Aspiration Biopsy, Fine-Needle at the US National Library of Medicine Medical Subject Headings MeSH
- MedlinePlus Encyclopedia 003860 - "Lung needle biopsy"
- ent/561 at eMedicine - "Fine-Needle Aspiration of Neck Masses"
- MedlinePlus Encyclopedia 003899 - "Thyroid nodule fine needle aspirate"
- MedlinePlus Encyclopedia 003658 - "Bone marrow aspiration"
- med/2971 at eMedicine - "Bone Marrow Aspiration and Biopsy"
- Risk of tumor cell seeding through biopsy and aspiration cytology 2014
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