WHAT IS A FINE NEEDLE ASPIRATION BIOPSY (FNA)?
Your health care provider has referred you for a fine needle aspiration biopsy (FNA). 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 biopsy procedure that may be painful, might cause scarring, and had an increased risk of complications. With the use of FNA, we can now sample your lump using only a thin small needle, which is smaller than the average needle used to draw blood.
WHAT ARE THE ADVANTAGES OF FNA?
FNA is the fastest and easiest method for biopsy of lumps that are easily palpable. Since the procedure does not require either anesthesia or stitches, patients are usually able to resume normal activities almost immediately after the procedure. Furthermore, this test will most often allow us to make a diagnosis or your lump within 1 to 2 days of the test.
WHAT IS THE FNA PROCEDURE LIKE?
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 of your questions and concerns have been addressed, the actual procedure will begin.
From the patient's perspective, the procedure will feel much like receiving an immunization injection. Prior to the FNA, the skin is cleansed with alcohol and then the area may be anesthetized with a small hypodermic needle. Many times, the area is not anesthetized for FNA because administering the anesthesia in certain areas may cause more pain for the patient than the procedure itself. Also, lidocaine (the anesthetic) may cause artifacts to appear in the biopsy specimen when examined under the microscope. Holding the lump with one hand, the doctor will sample the lump with a thin needle held in a needle holder. Most lumps require 2 to 4 samples to ensure adequate results.
HOW SHOULD PATIENTS PREPARE FOR AN FNA?
Patients may eat a regular meal prior to the procedure. Do not apply talcum powder, deodorant, lotion, or perfume in the area of the lump that is to be biopsied. Patients who take aspirin or ibuprofen (Motrin) should discontinue use 3 days prior to the procedure. Patients who take blood thinners should talk to their physician about whether they should discontinue using them prior to FNA.
HOW LONG DOES 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 20 minutes. However, please allow an hour for your visit because of registration and possible waiting time in the office.
WHAT COMPLICATIONS MAY ARISE?
FNA biopsy uses a very small needle to obtain a specimen, therefore, the technique is usually free of significant complications and offers much less risk to patients than many other biopsy procedures. The most common complication is 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 does not go away, signs of infection, continued bleeding, a fever over 100 degrees F, or if you experience pain that is not relieved by Tylenol or other non-aspirin products, call your doctor's office immediately.***
WHEN DO I GET THE RESULTS?
Generally, your results should be available from your referring surgeon or primary care provider's office in 1 to 2 working days. The primary physician will explain the results to his/her patient and answer any questions related to the diagnosis. The results can be grouped into 3 categories:
1. Clearly benign (not cancer)
2. Clearly malignant (cancer)
3. Not-definitive/Nondiagnostic (may require repeat FNA or surgical biopsy for diagnosis)
WHAT ARE THE LIMITATIONS OF FNA?
The goal of the FNA procedure is to determine the cause of the lump. In the majority of the cases, this goal is achieved but in a few cases, the test is inconclusive or insufficient material is obtained for a diagnosis to be made. Whenever the specific cause of a lump is uncertain, the primary physician may recommend surgery, repeat the FNA procedure or arrange some other type of study.
Despite careful performance of FNA biopsy, no medical test is 100% accurate. There is always a chance, albeit a small one that a FNA study will be inaccurate. Therefore, a lump should never be ignored after a FNA procedure. Lumps should always be monitored by patients for any changes that may occur. If changes do occur, it is highly recommended that you follow up with your primary care physician for treatment options.