Needle aspiration biopsy
Encyclopedia
Needle aspiration biopsy (NAB), may refer to fine needle aspiration cytology (FNAC), fine needle aspiration biopsy (FNAB) and fine needle aspiration (FNA), is a diagnostic procedure sometimes used to investigate superficial (just under the skin) lumps or masses. In this technique, a thin, hollow needle
is inserted into the mass for sampling
of cells that, after being stained, will be examined under a microscope
. There could be cytology exam of aspirate (cell specimen evaluation, FNAC) or histological (biopsy
- tissue specimen evaluation, FNAB). . 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 of America was done at Maimonides Medical Center
, eliminating the need for surgery and hospitalization. Today, this procedure is widely used in the diagnosis of cancer.
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.
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
, as well as for many types of body fluid sampling.
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 (I.V.) 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.
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:
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.
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.
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 subsequently.there may be other complications as well
Other complications depend upon the body part on which the biopsy takes place:
Lung - "Lung needle biopsy"
Neck - "Fine-Needle Aspiration of Neck Masses" - "Thyroid nodule fine needle aspirate"
Bone - "Bone marrow aspiration" - "Bone Marrow Aspiration and Biopsy"
Hypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
is inserted into the mass for sampling
Sampling (medicine)
In medicine, sampling is gathering of matter from the body to aid in the process of a medical diagnosis and/or evaluation of an indication for treatment, further medical tests or other procedures...
of cells that, after being stained, will be examined under a microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
. There could be cytology exam of aspirate (cell specimen evaluation, FNAC) or histological (biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
- tissue specimen evaluation, FNAB). . Fine needle aspiration biopsies
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
are very safe, minor surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a 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 of America was done at Maimonides Medical Center
Maimonides Medical Center
Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, Brooklyn. Maimonides is both a treatment facility and academic medical center with 705 beds, and more than 70 primary care and sub-specialty programs...
, eliminating the need for surgery and hospitalization. Today, this procedure is widely used in the diagnosis of cancer.
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.
Applications
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
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
. 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
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
or ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
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
Chorionic villus sampling
Chorionic villus sampling , sometimes misspelled "chorionic villous sampling", is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus and testing it...
, as well as for many types of body fluid sampling.
Preparation
Several preparations may be necessary before this procedure.- No use of aspirinAspirinAspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
or non-steroidal anti-inflammmatory medications (e.g. ibuprofenIbuprofenIbuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
, naproxenNaproxenNaproxen sodium is a nonsteroidal anti-inflammatory drug commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions such as:...
) 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 anticoagulantAnticoagulantAn anticoagulant is a substance that prevents coagulation of blood. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis...
medications; - AntibioticAntibioticAn antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
prophylaxis may be instituted.
Before the procedure is started, vital signs (pulse
Pulse
In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...
, blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
, temperature
Temperature
Temperature is a physical property of matter that quantitatively expresses the common notions of hot and cold. Objects of low temperature are cold, while various degrees of higher temperatures are referred to as warm or hot...
, etc.) may be taken. Then, depending on the nature of the biopsy, an intravenous line (I.V.) may be placed. Very anxious
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
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.
Procedure
The skinSkin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
above the area to be biopsied is swabbed with an antiseptic
Antiseptic
Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction...
solution and draped with sterile surgical towels. The skin, underlying fat, and muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
may be numbed with a local anesthetic
Local anesthetic
A local anesthetic is a drug that causes reversible local anesthesia, generally for the aim of having local analgesic effect, that is, inducing absence of pain sensation, although other local senses are often affected as well...
, although this is often not necessary with superficial masses. After locating the mass for biopsy, using x-rays or palpation
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...
, 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
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
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.
Post-operative care and complications
As with any surgical procedure, complications are possible. Fortunately, 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
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
is rare. But should an infection occur, it will be treated with antibiotics. Bleeding
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
is the most common complication of this procedure. A slight bruise may also appear. If a lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
or kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
biopsy has been performed, it is very common to see a small amount of blood in sputum
Sputum
Sputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections....
or urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
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.
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 subsequently.there may be other complications as well
Other complications depend upon the body part on which the biopsy takes place:
- Lung biopsies are frequently complicated by pneumothoraxPneumothoraxPneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...
(collapsed lung). This complication can also accompany biopsies in the upper abdomenAbdomenIn vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
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 liverLiver biopsyLiver biopsy is the biopsy from the liver. It is a medical test that is done to aid diagnosis of liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment.-History:...
, bileBileBile or gall is a bitter-tasting, dark green to yellowish brown fluid, produced by the liver of most vertebrates, that aids the process of digestion of lipids in the small intestine. In many species, bile is stored in the gallbladder and upon eating is discharged into the duodenum...
leakages may occur, but these are quite rare. - PancreatitisPancreatitisPancreatitis is inflammation of the pancreas. It occurs when pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine. It may be acute – beginning suddenly and lasting a few days, or chronic – occurring over many years...
(inflammationInflammationInflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the pancreasPancreasThe pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
) may occur after biopsies in the area around the pancreas. - Deaths have been reported from needle aspiration biopsies, but such outcomes are extremely rare.
External links
Breast - "fine needle aspiration cytology (breast)"Lung - "Lung needle biopsy"
Neck - "Fine-Needle Aspiration of Neck Masses" - "Thyroid nodule fine needle aspirate"
Bone - "Bone marrow aspiration" - "Bone Marrow Aspiration and Biopsy"