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Fine needle aspiration (FNA) and core biopsy

Breast Fine Needle Aspiration (FNA)

A Breast Fine Needle Aspiration (FNA) is a quick and simple procedure to perform, which removes some fluid or cells from a breast lesion or cyst (a lump, sore or swelling) with a fine needle similar to a blood sample needle. The sample of fluid or cells is smeared on a glass slide and sent to a pathology laboratory to be examined by a specialist doctor (a cytologist) under a microscope. An FNA is performed to help determine the nature or diagnosis of the lesion and to plan treatment if necessary.

Breast FNA may also be used to aspirate a cyst (that is, using the needle to draw fluid from the cyst) to remove it completely or relieve discomfort if the cyst is large and tender. This will performed with the guidance of ultrasound. 

How do I prepare for a Breast FNA?

There is no need for special preparation before a Breast FNA. Breast FNA can be done immediately after you have had a medical examination and any imaging your doctor may have referred you for, such as a mammogram and/or ultrasound to find out the cause of the lesion. Wear a comfortable two piece outfit, as you will need to have the upper body undressed for the Breast FNA.

Procedure

You will be lying on your back on the examination bed in the ultrasound room, the upper body undressed, with one arm above your head on the pillow in a comfortable position. The doctor will put a clear gel on your breast and the ultrasound transducer or probe (see Ultrasound) will be slowly moved across the breast to show and identify the lesion on the ultrasound screen. The doctor will clean your breast with an antiseptic liquid and place the needle through the skin and into the lesion guided by the ultrasound images.

Local anaesthetic on the skin area where the needle is inserted is sometimes given. If the doctor does not provide anaesthetic you can ask about this before the needle is inserted.

When the needle is inserted into the lesion, the doctor will make several small (less than 1 cm) forward and backward, gentle movements with the needle to collect cells or, if the lesion is a cyst, fluid may be collected. Two or three separate samples are usually taken in this way to ensure a good sample has been obtained.

What are the risk? 

Minor complications include some brusing or bleeding at the time of aspiration.  The more serious complications are haematoma (collection of blood) or infection at the site. If the lesion is very deep in the breast the need could penetrate beyond the breast tissue and reach the lung and cause an air leak. This leakage of air may be very minor and require no treatment. If the leakage of air is considerable a tube may have to be placed within the chest to drain the accumulated air. In the latter case, you may need to be hospitalised to monitor your treatment. In actual practise these are extremely rare complications and have to be balanced against the risk of missing a breast cancer. 

Breast Core Biopsy

A Breast Core Biopsy is where a special needle (or probe) is inserted into the breast to take a small sample of breast tissue from an area of concern so that it can be sent to a laboratory for testing. It is done using local anaesthetic to numb the breast in the area that is being biopsied. An abnormality may have been identified on a ultrasound or X-ray image or may have been felt as a lump.

How do I prepare for a Breast Core Biopsy 

Generally no preparation is needed. You should bring any recent breast imaging (mammograms and/or ultrasounds) and reports for the doctor performing the procedure to review before doing the biopsy.

Do not wear talcum powder or deodorant on the day of the biopsy as these can mimic or imitate calcium spots in the breast which makes it harder for the radiologist to identify the abnormality that requires biopsy. You might consider the clothes you wear on the day so you only need to remove clothes from the upper part of your body.

Procedure

The skin of the breast is washed with antiseptic and then a very fine needle is used to give local anaesthetic to numb the breast in the area for biopsy.  The local anaesthetic stings for only a few seconds when it is being given, and after this the area will be numb.

A small nick or cut is made in the skin and the biopsy needle is gently inserted into the breast.  Several samples are taken. When each sample is taken there is a clicking noise, and you may have a feeling of pressure in the breast where the sample is taken. The biopsy procedure may sometimes feel uncomfortable but is not usually painful because of the local anaesthetic that has been given.

After the samples have been taken, the biopsy area will be pressed on firmly for a few minutes to reduce bruising and bleeding, and then covered with a dressing

What are the risks of a Breast Core Biopsy?

You will usually have some bruising at the biopsy site and sometimes this may take several weeks to disappear.

There is a very small risk of infection. In the very unlikely event that the biopsy site becomes infected, a course of antibiotics may be required from your doctor.

Contact your doctor if you experience excessive swelling, bleeding, have fluid draining from the wound, redness or heat in the breast after the biopsy.

Doing a biopsy of tissue, especially if it is located deep within the breast, carries a slight risk that the needle (or probe) will pass through the chest wall, allowing air around the lung that could collapse a lung. This complication is a rare occurrence and is called a pneumothorax.

 

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