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Fine Needle Biopsy

Fine Needle Biopsy by Maria Adams, MS, MPH, RD Loading image. Please wait...

Anatomy and Physiology
Our bodies contain many different types of tissues that are combined together to make organs. Organs that work closely together toward the same purpose make up an organ system. Some of the main organs include:The kidneys, which are part of the urinary system. Kidneys help to eliminate waste products in the urine and maintain the balance of water and electrolytes in the blood.

The lungs, which are part of the respiratory system. Lungs provide the body with a constant supply of oxygen and remove carbon dioxide from the blood.

The liver, which is part of the digestive system. The liver has many functions, including breaking down fats, processing amino acids, storing carbohydrates, and detoxifying poisons and drugs.

The thyroid and pancreas, which are part of the endocrine system. Both organs serve to secrete hormones that travel in the bloodstream to other parts of the body and trigger physiological responses.

The prostate gland in men and the ovaries and breasts in women, which are part of the reproductive system. The prostate gland aids in the production of semen, while the ovaries produce eggs and the breasts produce milk to nourish a newborn.

The lymph nodes, which are part of the lymphatic system. Lymph nodes are located throughout the body along lymphatic vessels. They serve to collect and destroy infectious microorganisms and cancer cells.

Reasons for Procedure
A biopsy is a diagnostic procedure in which a sample of tissue or fluid is removed from the body for further examination in a laboratory. In a fine needle aspiration biopsy, a very thin needle is used to remove a sample of tissue. Needle aspiration (without the biopsy) involves the removal of fluid rather than tissue, although the fluid is also often sent to the laboratory for evaluation.

Biopsies are most commonly performed to evaluate a lump or mass felt on physical examination, or detected by x-ray or other imaging techniques. A lump or mass is sometimes referred to as a nodule.

A fine needle aspiration biopsy may be done to: determine whether or not a suspicious lump or mass is cancerous, evaluate how well certain treatments are working, needle aspiration may also be done to determine whether a particular lump or mass is solid or cystic. If fluid is aspirated, a cyst is confirmed.

Fine needle aspiration biopsies can be performed on many different tissues and organs. This type of biopsy is commonly done on the breast, thyroid, and lymph nodes. Other potential sites include the: kidneys, liver, lungs, pancreas, prostate, and/or ovaries.

Treatments
In many cases, a doctor is able to make an accurate diagnosis by performing a thorough history and physical examination. If not, he or she will often obtain blood samples or other non-invasive imaging tests, such as: ultrasound, which uses high-pitched sound waves to produce images; CT scans, which use x-rays and computers to produce detailed images; MRI scans, which use a high-powered magnet, radio waves, and computers to produce even more detail; radioisotope scans, which use radioactive materials and detectors to assess the function of organs.

Sometimes, however, a reliable diagnosis cannot be made without obtaining a sample of tissue. This is especially true if cancer is suspected. Since a fine needle aspiration biopsy is the least invasive type of biopsy, it is often the procedure of first choice.

Imaging studies, like those previously described, are often used to help target the biopsy.

The other main types of biopsy procedures are large-core needle, incisional, and excisional biopsies. A large-core needle biopsy is similar to a fine needle biopsy, except it uses a larger needle. It is most commonly used for retrieving samples from the prostate gland and the breast.

In an incisional biopsy, a portion of the lump or mass is removed through a small incision in the skin. This has the advantage of minimizing the size of the incision and the amount of tissue removed, but it does leave some of the lump or mass behind. In an excisional biopsy, the entire lump or mass is removed through an incision in the skin. This has the advantage of completely removing the area of concern but usually requires more extensive surgery.

Procedure
During the time leading up to your needle biopsy: Your doctor may order routine blood work and other studies in preparation for your procedure. Do not take aspirin or similar products, such as ibuprofen, for one week prior to the procedure unless otherwise advised by your doctor. If you regularly take medications, herbs, or dietary supplements, your doctor may ask you to temporarily discontinue them. Do not start taking any new medications, herbs, or dietary supplements without consulting your doctor. In certain cases, you may be given antibiotics to lower the risk of an infection from the procedure. Depending on the location of your biopsy, you may be asked to not eat or drink the day of your procedure. If your biopsy requires the use of a CT scan, you may be asked to drink contrast material. Arrange for a ride to and from the hospital or doctor's office.

A fine needle aspiration biopsy is usually performed in a doctor's office or in the hospital. Surface biopsies closer to the skin are simpler and more often performed in a physician's office. Biopsies that are deeper in the body or require the guidance of ultrasound or a CT scan are usually performed in the hospital.Loading image. Please wait...

Your doctor will position you so that he or she can easily access the area to be biopsied. Your doctor will then swab this area with a cleaning solution and may also drape the surrounding areas with surgical towels. In some cases your doctor may numb the area where the needle is to be inserted with a local anesthetic.

Your doctor will insert a thin, hollow needle through the skin to the biopsy site. When the needle is in the proper position, your doctor will withdraw a sample of tissue or fluid. You may feel a pinch, pressure, or nothing at all.

Your doctor may insert the needle more than once in order to attain the appropriate positioning or to obtain multiple samples.

In an ultrasound-guided biopsy, your doctor will locate the suspicious area with an ultrasound probe before inserting the needle. In a CT-assisted biopsy, you will lie down and the CT scan will pass over the region to be biopsied, allowing your doctor to locate the precise area to insert the needle.

After the needle is withdrawn, pressure will be applied to stop any bleeding, and the site will be covered with a bandage. A simple in- office biopsy usually only takes a few minutes. A deeper biopsy, or one that is guided by ultrasound or CT, generally takes 15-45 minutes.

Risks and Benefits
A fine needle aspiration biopsy is a low-risk procedure. Still there is a chance that complications may occur, including: Bleeding-this is the most common complication; you may, for example, notice a small amount of blood in your sputum after a lung biopsy or in your urine after a kidney biopsy, bruising at the site of the needle insertion, persistent pain at the site of the needle insertion, pneumothorax, or a collapsed lung; this may occur during biopsies of the lung, liver, or kidney, infection-although this is generally very uncommon.

Benefits of a fine needle aspiration biopsy include: precise diagnosis of a suspicious lump or mass, minimal invasiveness compared to other types of biopsy procedures.

In a fine needle aspiration biopsy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate procedure for you.

After the Procedure
After the procedure: You will be allowed to go home. Your doctor will provide you with specific care instructions based on the location of your biopsy. In general, the biopsy site should be kept clean and dry for 24 hours. Your doctor will send the tissue or fluid sample to a lab for testing and will contact you when the results are available.

After your biopsy, it is normal to feel some soreness at the needle insertion site. However, be sure to contact your doctor if you notice: persistent bleeding, increasing or persistent pain, redness, swelling, or discharge from the biopsy site, fever, shortness of breath or cough, especially in the case of a lung, liver, or kidney biopsy.

Sources:

  • Dictionary of Cancer Terms. National Cancer Institute. Available at: http://www.cancer.gov/dictionary/db_alpha.aspx?expand=b. Accessed September 14, 2004.
  • Fine Needle Aspiration. American Family Physician. Available at: http://www.aafp.org. Accessed June 9, 2003.
  • Fine Needle Aspiration and Biopsy: Frequently Asked Questions. Virtual Hospital. Available at: http://www.vh.org/adult/patient/pathology/faq/needleaspiration.html. Accessed September 8, 2004.
  • Preparing for a Needle Aspiration Biopsy. Patient Information Publications. National Institutes of Health. Available at: http://www.cc.nih.gov/ccc/patient_education/pepubs/needle.html. Accessed September 14, 2004.
  • Thyroid fine needle aspirate. MedlinePlus. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003899.htm. Accessed September 8, 2004.
  • Zaret BL, Jatlow PI, and Katz LD. The Yale University School of Medicine Patient's Guide to Medical Tests. New York: Houghton Mifflin Company; 1997.


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Copyright © 2003 Nucleus Medical Art, Inc. All Rights Reserved.
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