Fine Needle Aspiration - Making The Diagnosis: Breast Cancer

Content provided by the Faculty of the Harvard Medical School

Fine needle aspiration

A doctor can do fine needle aspiration (also called a FNA) in the office by inserting a very slender needle into the area of concern and drawing out (aspirating) either fluid from a cyst or a small amount of tissue from a solid mass. Although this procedure is sometimes called a FNA biopsy, it is different from other breast biopsies. It is intended to draw out a core of tissue from a suspicious area in the breast. Tissue from a mass, and sometimes fluid from a cyst, is then sent for microscopic evaluation to determine whether cancer is present.

Aspirating a cyst: Not all cysts need to be drained. If the cyst is a simple cyst (one that looks clear under ultrasound) and isn't causing discomfort, it usually doesn't require aspiration.

Fine needle aspiration is commonly used to drain a tender cyst or a complex cyst. The tender cyst is drained to confirm that it is a simple cyst and also to provide pain relief. A complex cyst is one that appears on ultrasound to contain cellular materials or tissue within the fluid. In rare cases, the cellular material could represent cancerous cells.

Sometimes fluid from the cyst will be bloody. When that happens, the doctor will send the fluid to be analyzed in the laboratory to determine whether the material contains cancerous cells.

Even if the cells that are removed during aspiration are noncancerous, the doctor may still recommend further testing if there is any concern that there is a cancer. This may occur if the cytopathologist (the specialist who examines the cells under a microscope) cannot make an unequivocal diagnosis of cancer, but does notice some irregularities in the appearance of the cells

Aspirating a sold mass: With fine needle aspiration of a solid mass, the doctor uses a slightly different technique. The doctor inserts the slender needle through the skin into the mass. Suction is applied to pull cells out of the mass. The cells are spread on a slide that is sent to the pathology laboratory. Or, the doctor may decide to use a needle that can remove a core of the solid mass to obtain more material for examination under the microscope.

If the cells are definitely cancerous, the patient and doctor can proceed with plans for treatment. However, if the cells appear benign, the patient will still need further diagnostic evaluation with either a large core needle biopsy or open surgical biopsy.

Last updated:	April 23, 2007