Fine Needle Aspiration Biopsy

The discovery of a lump

anywhere in the body
isThe
of quickest and least
major concern to
painful way to obtain
both patient and doctor.
Theanquickest
accurateand
tissue
least
diagnosis
painful wayoftoa lump
obtain
anywhere in the body
an accurate tissueis by
Fine Needle
diagnosis is by
Aspiration Biopsy.
Fine Needle
Aspiration Biopsy.
Three Steps in Aspiration Biopsy diagnosis:
Ultrasound + Biopsy + Microscopy

1. Ultrasound
The lesion to be biopsied is first
evaluated by ultrasound. The
position of the lesion, its size,
and most importantly its
relationship to adjacent
structures (bones, chest wall,
blood vessels, nerves etc) are
determined before the biopsy is
performed.

In a complex mass, ultrasound

guidance helps determine the
specific areas of the lump that
need to be biopsied.
2. Biopsy Procedure
A very
A thin needle
very thin needle (23gauge
(23gauge or
or
25gauge) is
25gauge) is used.
used. This
This is
is
approximately half the thickness
of a blood-taking needle.

No local
No local anaesthetic
anaesthetic is
is required
required as
as
the biopsy
the biopsy in
in most
most instances
instances is
is
usually no more painful than a
blood test.

In addition
In addition injecting
injecting local
local
anaesthetic dilutes
anaesthetic dilutes the
the biopsy
biopsy
sample and
sample and compromises
compromises the the test.
test.
Another important
Another important reason
reason isis that
that
and blur
the local anaesthetic can the
bleeding
ultrasound picture and render
caused by the injection can blur the
localization of theand
ultrasound picture lump difficult.
render
localization of the lump difficult.
Usually 2 samples are taken. More
Usually 2may
samples samples are taken.
be required in aMore
large
samples may be required in a large
or complex lesion or in a lump that
or complex
contains lesion
very or in a lump that
few cells.
contains very few cells.
3. Immediate Microscopy
A smear of the aspirated sample is made on a glass slide (just like a Pap smear).
This is stained and examined immediately by the pathologist. This is essential for
the following reasons:

• Check for adequacy - If there is insufficient material the biopsy is repeated

immediately. This ensures that diagnostic material is obtained every time.

• Confirmatory tests. Immediate microscopy and provisional diagnosis means

that material required for confirmatory tests is obtained immediately,
eliminating the need for a repeat biopsy at a later date.
E.g. Culture for tuberculosis, Flow cytometry for lymphoma,
Immunoperoxidase for certain types of cancer etc.

Using ultrasound and immediate microscopy we

achieve a diagnosis in more than 95% of cases
Sites of Fine Needle Aspiration Biopsy

DEEP BIOPSIES
(LUNG, LIVER,
KIDNEY ETC.) ARE
PERFORMED UNDER
CT CONTROL.

The ‘Triple’ Diagnosis

No diagnostic modality is 100% accurate hence the value of the ‘Triple Diagnosis’.

Triple diagnosis is the combination of three tests – 1. Clinical Examination,

2. Radiology, and 3. Fine needle aspiration biopsy. The combination of these three
tests can achieve a diagnostic accuracy of more than 95%.
For example in breast lesions Clinical Examination can miss up to 15% of
cancers, Mammography / Ultrasound up to 10% and Fine needle aspiration
cytology up to 9%. However combined as the triple test the detection rate is
up to 99.6%.
Reference: Investigation of a new breast symptom. National Breast Cancer Centreguidelines – October 1997.
FNA - Answers to commonly asked questions
What is Aspiration Biopsy?
A biopsy is sampling of an abnormal area such as a lump in the breast, a
nodule in the thyroid or an enlarged lymph gland. Sampling by aspiration
biopsy is similar to sampling blood from a vein in your arm. A hollow
needle similar to that used to draw blood is inserted into the lump and a
drop of semisolid material withdrawn for testing.

What is the purpose of performing an Aspiration Biopsy?

A lump in your body can be the result of scar tissue, a cyst, an infection,
an abnormal growth such as cancer, etc. Indirect tests such as X-rays and
blood tests are usually not sufficient to determine the exact nature of the
lump. Aspiration cytology, by analyzing tissue taken directly from the
lump, gives an accurate diagnosis and helps your doctor determine
appropriate treatment.

Who will perform my biopsy?

Your biopsy will be done by Dr Edward Chandraratnam.

What is involved in the Aspiration Biopsy procedure?

Dr Chandraratnam first examines your lump clinically (by feeling it) and
by ultrasound. He then measures the size of the lump, and notes its exact
location so that you and your doctor can be sure exactly what area was
sampled. The biopsy needle, which is thinner than that normally used to
draw blood, is attached to a small syringe and gently inserted into your
lump for a few seconds and the sample collected.
Usually two samples are taken from different areas of the lump. This
ensures that sampling is reasonably representative of the entire lump.
More samples may be required in a large or complex lesion or in a lump
that contains very few cells.
After the biopsy, firm pressure is applied to the lump to stop any
bleeding. The sample is then immediately checked to ensure that an
adequate sample has been obtained.

The biopsy procedure is described in detail in the following pages.

When will the results be available?
The results usually take 48 hours and are sent directly to your doctor (who
referred you to us). You should contact your doctor to discuss the biopsy
results, what they mean and what, if anything, should be done next.

If it is cancer will the biopsy cause it to spread?

No. Experience world wide for over 50 years has shown that fine needle
aspiration biopsy is a very safe diagnostic procedure.

What are limitations of aspiration biopsy?

No medical investigation is 100% accurate, despite the care devoted to each
biopsy. In our experience the chance of the biopsy failing to find a malignancy
that is present is up to 10%. Thus neither you nor your doctor should take a
benign diagnosis as final and forget your lump. Instead you should continue in
your doctor’s care so that he or she can watch the lump and/or do other
investigations such as X-rays or laboratory tests. If the lump enlarges, it is
imperative that we re-sample it or it is surgically removed as this may indicate
an underlying cancer.

What are the possible complications?

The most common complication that occurs in about a quarter of our patients is
bruising, tenderness, or mild swelling in the area of the biopsy. In our
experience this is mild and requires no specific medical attention and
disappears within a few days. Some patients note that an ice pack or mild non-
aspirin medication (such as panadol) helps. Complications such as rapid
swelling, bleeding or infection are extraordinarily rare. If these or any unusual
symptoms occur please call your doctor or Austpath immediately.

Are you having second thoughts?

Most patients look upon aspiration biopsy as they would a blood test. However
some put off scheduling the biopsy, or fail to keep an appointment, for a variety
of reasons. These include a fear of needles, or a fear of what the biopsy may
find. Rather than risk delay in your diagnosis, we urge you to make and keep
your appointment with us. In the meantime, write down your questions so that
you will not forget them. Then come in and see us. You have our assurance that
your questions will be answered in clear, easy to understand language. If, after
this discussion, you still do not desire the biopsy, we will respect your decision.
Later, if you change your mind, we will gladly re-schedule the appointment.
 LABORATORIES

Westmead
160 Bridge Road

Fairfield
28 Kenyon Street

Cabramatta
119B John Street

All Appointments
(02) 8836 3333
Clinical Consultation
Dr Edward Chandraratnam – (02) 8836 3333

This laboratory is accredited by the National Association of Testing Authorities

and the Royal College of Pathologists of Australasia.