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Why did my doctor order this test?
What is Fine Needle Aspiration (FNA)?
What are the goals of FNA?
Will the FNA procedure be painful?
Is there any special preparation I need to do before the biopsy?
How is the visit conducted and FNA procedure performed?
What are the possible complications?
Will the biopsy make the tumor spread?
How are the FNA results obtained?
Are you thinking of not coming in?
Your health care practitioner has referred you to us for Fine Needle Aspiration (FNA) of a lump or bump that was easily felt or seen on your radiographic imaging studies (e.g., ultrasound, CT scan or MRI).
FNA is a minor outpatient, "through the skin" (percutaneous), procedure that uses a very small needle, much smaller than what you would get your blood drawn with, to remove cells from your lump or bump for examination under the microscope in order to help determine its cause.
FNA is considered a quick (less than 5-10 seconds for each FNA sample), safe, and cost-effective procedure over surgical excision. FNA is used in the diagnosis of lumps commonly encountered in the thyroid gland, under the skin, breast, salivary glands, and to evaluate lymph nodes. Any lump within about 1½ inches deep to the skin may be amenable to this simple procedure by us.
Our goal is to determine the cause of your lump, which we can do in over 90% of the cases. In about 5% of the time, we can usually narrow the cause of the lump to a small number of likely possibilities. In only about 2-4% of patients that we FNA, the sample may be too limited to help your doctor. For either of these last two cases, your doctor might recommend a repeat FNA, a surgical biopsy or excision, or additional tests to further investigate your lump.
Despite our best ability, no FNA procedure is 100% accurate. The chance of your FNA failing to find cancer when it is present is around 3-5%. Thus, neither you nor your physician should take a benign interpretation as an indication to forget your lump. Instead, you should continue in your doctor's care so that both of you can watch your lump. If it enlarges, it is imperative that you be reevaluated by your doctor and the lump can either be resampled or surgically removed, as these changes may rarely indicate an underlying cancer not identified by your initial FNA.
Rarely, there are times when we cannot feel your lump or definitely identify it on our limited ultrasound exam. If the lump cannot be felt or clearly identified by us on ultrasound, we cannot perform the FNA. If this happens, we will discuss it with your doctor who can then best advise you on any additional tests, if needed. It is important to follow-up and seek your original doctor's advice because our inability to feel or identify a lump does not necessarily rule out a serious medical condition or cancer.
The procedure usually involves only minor discomfort, comparable to getting your blood drawn. The use of a very small biopsy needle and the very short time of each actual needle puncture, 5-10 seconds, eliminates the need for local anesthesia in the majority of cases. We will gladly discuss all your pain reducing options with you before the procedure, and be reassured that we will not hesitate to use them.
You may eat a regular meal prior to the procedure. Wearing loose fitting clothing that is easily removed is advantageous if your lump is in an area that may need partial removal of your clothing to access it (e.g., breast or upper leg). If you take aspirin or ibuprofen, ask your referring doctor if you can safely discontinue its use 3 days prior to procedure as this will help decrease bleeding or bruising from the FNA procedure. For patients who take blood thinners (e.g. Coumadin, warfarin, Plavix etc.), you should talk to your doctor about whether you should discontinue using them prior to FNA or have your doctor’s office call us to discuss your options if you cannot stop the medications.
Your visit will begin with us reviewing your medical records and any radiology studies provided to us such as previous ultrasound scans, CT, or MRI studies. We will then ask you questions about your lump such as where it is located, how long it has been there, or if there have there been any changes to it.
We will next perform a focused physical examination that begins by feeling (palpating) the lump. We may use our ultrasound machine to help us “see” through your skin and to gather additional information about your lump. We may also use ultrasound to help us direct our FNA needle if needed during the procedure especially if your lump is not easily felt.
The biopsy procedure begins by us cleansing your skin with alcohol. A very small needle is then inserted through your skin and into the lump and multiple in and out needle motions are performed over 5-10 seconds. Several needle samples (3-6) may be required to ensure that an adequate tissue sample is taken and to collect cells for additional studies to aid in making our diagnosis if needed. Pressure will then be applied to the biopsy area after the needle is withdrawn.
The cells removed by the needle are then placed on a microscope slide, stained and examined by us (cytopathologists) under the microscope.
FNA does not require stitches as only tiny holes in your skin may or may not be visible after the procedure. Sometimes a small band aid is placed. You may resume your normal daily activities the same day of the FNA procedure.
FNA by an experienced practitioner is virtually free of significant complications. The most common complications are bruising, slight swelling, or tenderness in the area of the biopsy. Most cases are mild in nature, require no specific medical attention, and they usually resolve within hours or in some cases a few days. An ice pack or non-aspirin medication (such a Tylenol) can help if you experience these mild symptoms. Complications such as rapid swelling, re-bleeding at the biopsy site or within your lump or cyst if it was drained, pneumothorax, difficulty breathing, or infection are extraordinarily rare. If these or any unusual symptoms occur, please seek emergency medical treatment immediately. During your visit, we will discuss these and any additional possible complications that may be particular to you, and you will receive written and verbal post-FNA instructions from us.
Any time a lump is biopsied, it raises the concern that the biopsy might cause a tumor, if present, to spread. Many studies have shown that this risk is extremely low, especially in today’s FNA practice where very fine needles (by definition: a needle diameter of 0.028 inches/0.72 mm or smaller) are used. Hundreds of thousands of FNAs have been performed worldwide, and less than two dozen instances of tumor spreading as a consequence of FNA biopsy have been reported. In all of these reported cases, the biopsy was performed using large needles that are, in fact, not technically considered “FINE” needle biopsies as properly defined. In the rare cases where localized biopsy needle tract seeding by tumor did occur, it does not seem to affect a patient’s prognosis because these tracts can be surgically removed without recurrence. Given the rarity of tumor spread and the easiness and effectiveness of surgical removal of any localized seeding, the application of FNA should not be deterred, when indicated.
It has been confirmed in our practice and in the world literature that FNA results can be more accurate when the doctor who performs the biopsy is also the one who interprets the sample. At our Cytodiagnosis Center, the doctor who performed your biopsy (a cytopathologist) will personally examine your slides and determine the diagnosis. We will provide you and your doctor with a written or verbal preliminary “adequacy” assessment at the conclusion of your FNA procedure to indicate if we think we may have enough cells to make a diagnosis, which is in over 95% of the cases. We will also provide a written report to your doctor's office within 4 business days (excluding any additional time for any special studies that may need to be performed or requested on your sample, which may delay your final report by a few more days). If you wish to know the results of your biopsy before your next scheduled appointment, contact your doctor directly. He or she can best explain exactly what the test results mean for you and what, if anything, should be done next.
If your doctor is concerned enough to order evaluation of your lump or bump by FNA, we urge you keep your appointment with us rather than risk a delay in your diagnosis. We realize, however, that some patients may want to cancel or fail to keep their appointment for a variety of reasons. These may include fear of needles or a fear of what the biopsy might find. If this is the case, please write down your questions or concerns so you won't forget them. Then, come in to see us. As physicians it is our duty to provide you with information and the answer to your questions, and you have our assurance that we will give you direct, straightforward answers.
If there is still a desire not to have the FNA after our discussion together, we will respect your decision and you will be free to leave. We will not pressure you into having a procedure you do not want. Later, if you change your mind, we will gladly reschedule your appointment.