Needle aspiration biopsy (
NAB), also known as
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 to extract cells that, after being stained, will be examined under a
microscopeA microscope is an instrument to see objects too tiny for the naked eye. The science of investigating small objects using such an instrument is called microscopy. Microscopic means invisible to the eye unless aided by a microscope.-History:An early microscope was made in 1590 in Middelburg, The...
. Fine needle aspiration
biopsiesA biopsy is a medical test involving the removal of cells or tissues for examination. It is the 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
surgicalSurgery is a 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, to help improve bodily function or appearance, or sometimes for some other reason...
procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead.
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 biopsy is performed for one of two reasons:
- A biopsy is performed on a lump or 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
surgeonIn medicine, a surgeon is a person who performs 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 to remove a diseased organ or to repair a tear or breakage. Surgeons may be medical doctors,...
. 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-rayX-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 10 to 0.01 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...
or
ultrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Although this limit varies from person to person, it is approximately 20 kilohertz in healthy, young adults and thus, 20 kHz serves as a useful lower limit in describing ultrasound...
guidance. In this case, the procedure may require more extensive preparation and take more time to perform.
Preparation
Several preparations may be necessary before this procedure.
- No use of aspirin
Aspirin , 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....
or aspirin substitutes (e.g. ibuprofenIbuprofen is a non-steroidal anti-inflammatory drug originally marketed as Brufen, and since then under various other trademarks , most notably Nurofen, Advil and Motrin...
, naproxenNaproxen Sodium is a non-steroidal anti-inflammatory drug commonly used for the reduction of mild to moderate pain, fever, inflammation and stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, menstrual cramps,...
) 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 anticoagulant
An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders...
medications;
- Antibiotic
In common usage, an antibiotic is a substance or compound that kills or inhibits the growth of bacteria...
prophylaxis may be instituted.
Before the procedure is started, vital signs (
pulseIn medicine, a person's pulse is the arterial palpation of a heartbeat. It can be palpated in any place that allows for 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 ankle joint...
,
blood pressureBlood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum and a minimum pressure...
,
temperatureIn physics, temperature is a physical property of a system that underlies the common notions of hot and cold; something that feels hotter generally has the higher temperature. Temperature is one of the principal parameters of thermodynamics...
, etc.) may be taken. Then, depending on the nature of the biopsy, an intravenous line (I.V.) may be placed. Very
anxiousAnxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry....
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
skinThe skin is the outer covering of the body. In humans, it is the largest organ of the integumentary system made up of multiple layers of mesodermal tissue, and guards the underlying muscles, bones, ligaments and internal organs. Skin of a different nature exists in amphibians, reptiles, birds...
above the area to be biopsied is swabbed with an
antisepticAntiseptics 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
muscleMuscle is the contractile tissue of the body 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 anestheticA local anesthetic is a drug that causes reversible local anesthesia and a loss of nociception. When it is used on specific nerve pathways , effects such as analgesia and paralysis can be achieved....
, although this is often not necessary with superficial masses. After locating the mass for biopsy, using x-rays or
palpationPalpation 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
syringeA syringe is a simple piston 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,
infectionAn infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the...
is rare. But should an infection occur, it will be treated with antibiotics.
BleedingBleeding, 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
lungThe lung or pulmonary system is the essential respiration organ in 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 in the chest on either side of the heart...
or
kidneyThe kidneys are paired organs, which have the production of urine as their primary function. Kidneys are seen in many types of animals, including vertebrates and some invertebrates. They are part of the urinary system, but have several secondary functions concerned with homeostatic functions. ...
biopsy has been performed, it is very common to see a small amount of blood in
sputumSputum is matter that is expectorated from the respiratory tract, such as mucus or phlegm, mixed with saliva, which can then be spat from the mouth. It is usually associated with air passages in diseased lungs, bronchi, or upper respiratory tract...
or
urineUrine is a liquid waste product of the body secreted by the kidneys by a process of filtration from blood called urination and excreted through the urethra. Cellular metabolism generates numerous waste compounds, 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. http://bmj.bmjjournals.com/cgi/content/full/328/7438/507
Other complications depend upon the body part on which the biopsy takes place:
- Lung biopsies are frequently complicated by pneumothorax
In medicine , a pneumothorax is a potential medical emergency wherein air or gas is present in the pleural cavity. A pneumothorax can occur spontaneously. It can also occur as the result of disease or injury to the lung, or due to a puncture to the chest wall...
(collapsed lung). This complication can also accompany biopsies in the upper abdomenIn 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 liver
Liver 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:...
, bileBile or gall is a bitter yellowish, blue and green fluid secreted by hepatocytes from the liver of most vertebrates. In many species, bile is stored in the gallbladder between meals and upon eating is discharged into the duodenum where the bile aids the process of digestion of lipids by...
leakages may occur, but these are quite rare.
- Pancreatitis
Pancreatitis is inflammation of the pancreas that can occur in two very different forms. Acute pancreatitis is sudden while chronic pancreatitis "is characterized by recurring or persistent abdominal pain with or without steatorrhea or diabetes mellitus."...
(inflammationInflammation is 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 as well as initiate the healing process for the tissue. Inflammation is not a...
of the pancreasThe 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 an exocrine gland, secreting pancreatic juice containing digestive enzymes that pass to...
) may occur after biopsies in the area around the pancreas.
- Deaths have been reported from needle aspiration biopsies, but such outcomes are extremely rare.
Source
- Adapted from Preparing for Needle Aspiration Biopsy. Public domain text of the National Institutes of Health
The National Institutes of Health is an agency of the United States Department of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. It consists of 27 separate institutes and centers which includes the Office...
Warren Magnuson Grant Clinical Center.
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"