Fine Needle Aspiration Biopsy (FNA) - What is a Fine Needle Aspiration Biopsy?
Definition:
A test done to see if a tumor is benign (non-cancerous) or malignant (cancerous.)
Fine needle aspiration (FNA) is done by inserting a thin needle into a tumor and removing cells that can be evaluated under the microscope. A pathologist looks at the cells to see if the suspicious tumor is cancer, and if it is cancer, what type of cancer.
With lung cancer, the needle is inserted into the chest through the skin. Doctors can make sure the needle goes to the right part of the lung by watching it through ultrasound or a CT scanner. If a lesion is more easily approached than those in the lung (for example, lymph nodes that can be felt), FNA may be used on that site instead of the lungs.
FNA is less invasive than an open biopsy, which is a biopsy that requires an incision in the skin to remove tissue. The most common problems with the test are bleeding or an air leak (pneumothorax) that may require further treatment.
Also Known As: needle aspiration biopsy (NAB), fine needle aspiration cytology (FNAC)
Fine Needle Aspiration FNA Biopsy of the Thyroid
Questions & Answers
The most common method for evaluation of a suspicious thyroid nodule is a technique known as fine needle aspiration, or FNA.
In an FNA, a very fine, thin needle is inserted into the thyroid, and aspirates (or "suctions") cells and/or fluid from a thyroid nodule or mass into the needle. The sample obtained can then be evaluated for the presence of cancerous cells.
How Does FNA Differ From Needle Core Biopsy?
In a needle core biopsy, a thicker, large needle is used to obtain a "core" tissue sample for analysis, and the larger sample that can be recut for smaller samples that can be sent out for further analysis. Needle biopsies are typically done using local anesthesia, and these procedures have slightly greater risk of bleeding associated with them, so they are more often done by a surgeon in outpatient or ambulatory surgical facilities.
If an HMO or community does not have practitioners with expertise in performing FNA, or there are not cyopathologists available to do the unique form of interpretation needed for FNA results, patients are likelier to have a core needle biopsy, as this procedure, while more invasive for patients, requires less skill to obtain a valid sample, and less skill for pathologists to read and interpet.
Who Should Perform an FNA?
Typically, FNAs are done by by endocrinologists, cytopathologists, or surgeons. The cells are studied and assessed by a cytopathologist.
Make sure that the practitioner has extensive experience in doing fine needle aspirations. Ask how many aspirations the practitioner does each month, and ask their "unsatisfactory" or "inconclusive" specimens rate. Don't always assume an endocrinologist is particularly skilled in this technique - he or she may not regularly perform this procedure.
The rate of non-diagnostic or unsatisfactory specimens - samples that cannot be used for laboratory assessment, and must be redone -- can be high for some less experienced practitioners. Yolanda Oertel, M.D., a cytopathologist from the Washington Hospital Center who spoke about FNA at the September 2000 Thyroid Cancer Survivor's Association (ThyCa) Conference in Washington, DC, cautions patients to find out the rate at the facility where their aspiration is taking place. The average can run from 5% to 15%. Dr. Oertel, whose practice focuses on thyroid and breast aspirations, and who aspirates approximately 90 thyroids each month, has a "non-diagnostic" rate is less than 0.5 percent.
Where Is an FNA Performed?
Many FNAs are performed in a doctor's office, although some might be done as outpatient surgery.
At ThyCA 2000, however, Dr. Oertel recommended that patients not get an FNA outside a hospital setting. While the procedure is generally safe, and things seldom go wrong, there is a very small risk of hermorrhage, but that could be quickly treated in a hospital setting.
What is an Ultrasound-Guided FNA?
When a nodule is palpable - meaning, you can feel it with your hand - most practitioners don't need to use ultrasound to guide the FNA process.
Some nodules are very low lying or can only be felt when you are swallowing, or can't be felt but were picked up by ultrasound, cat scan or MRI. In these cases, a practitioner may use ultrasound to ensure that the FNA is accurately performed.
Is FNA Risky?
Thyroid FNA is generally considered safe, and almost never results in any complications.
Cancer - Types of Biopsy
Types of Biopsy...
Fine needle aspiration is a technique widely used in Sweden for decades but only recently has become commonly used in the US. FNA is performed using a needle no larger than one typically used to give an injection; it is inserted into a lump or tumor and thousands of cells are drawn up into the needle.
For tumors located deep within the body such as lung, pancreas, liver, and thyroid fine needle aspiration allows biopsy without major surgery. FNA can be performed under the direction of a radiologist and anethesia is not required. Major surgery may still be neccessary for some patients due to other complications; pancreatic cancer often causes pressing on the bile ducts and requires surgery to reroute the bile duct of patients who have become jaudiced or yellow from the build up of bile in their system. An excisional biopsy removes a whole lump or an entire organ; this type of biopsy is less common today due to fine needle aspiration, however some types of tumors such as; lymphoma, breast lumps, and the spleen are still usually biopsied using the excisional method.
Lymphoma can only be properly examined if the whole cell is present. Many physicians prefer to remove complete breast lumps to achieve the greatest accuracy in diagnosis and the spleen cannot be cut into without danger so most surgeons will opt for complete removal of the spleen.
For tumors of the soft tissues (fat, muscle, and connective tissues) an incisional biopsy is usually performed and only a portion of the tumor is removed for evaluation. The purpose of this type of biopsy is to determine weather the tumor is a malingant tumor, called sarcomas or a benign condition.
Endoscopic biopsy is a commonly performed type of biopsy. A fiberoptic endoscope is inserted into the body through the appropriate body orifice or a small surgical incision. A fiberoptic endoscope is a flexible tube which allows visual examination and biopsy of an abnormal area, in the lining of the organ in question. Tiny bits of tissue are removed with forceps attached to the end of a long cable inside the endoscope. These tissues are then examined by the pathologist.
A colposcopic biopsy is performed by your gynecologist, usually in his office to further evaluate abnormal pap smear results. Most abnormal pap smear results do not indicate cancer. A coloposcope is placed about six inches from the vagina and allows a visual examination of the cervix as well as, allowing the removal of cells for biopsy.
Dermatologists typically use a punch biopsy to evaluate skin rashes and small areas of concern. A punch biopsy is performed using an instrument much like a small cookie cutter; a round tissue sample, about 3-4 cm is removed and the area is usually closed with a suture.
A bone marrow biopsy is performed when abnormal and unexplained blood count results are received. Unexplained anemia, high white cell count, and low platelet counts are indicators for bone marrow biopsy. Anesthesia is used but it may still be uncomfortable because it is impossible to deaden the inside of the bone.
A bone marrow biopsy is taken while the patient lies on their stomach and is usually removed from the posterior superior iliac spine, the part of your back where bikini dimples are often seen.
A bone marrow biopsy is much like a fine needle aspiration; but a larger and stronger needle is required to bread through the bone to the marrow. This is usually followed by a core biopsy which removes calcium from the bone to make the bone softer so the needle can reach the inner bone to remove tissue samples.
Once the biopsy tissue sample is removed it is sent to the pathologist and only the pathologists report can give you a definite cancer diagnosis.
Cancer Treatments...
Cancer treatments vary according to the type of cancer and the extent of the tumor. In some cases the diagnostic procedure is also a treatment procedure, as in some colposcopic procedures and hysterectomies An excisional biopsy performed to diagnose breast cancer may also remove the cancer; follow up treatments may include radiation and/or chemo. Thanks to early diagnosis of breast cancer through regular mammogram screenings and monthly breast self- examines the survival rate for breast cancer has increased tremendously.
The treatment for your cancer will be determined by the type of cancer diagnosis you have received, as well as the extent to which it has developed. Three cancer treatments most commonly used are surgery, chemo therapy, and radiation treatments. Other less commonly used treatments include; lasers, which are most useful for areas on the surface of the body or for areas that can be reached by an endoscope; hyperthermia which applies heat to directly to the tumor; and cryosurgery which freezes tumor masses and is useful in liver tumors; cyrosurgery is also being used experimentally in prostate cancer.
If you have undergone a surgical procedure you will begin your chemo and/or radiation treatments when your physician feels you have recovered sufficiently to withstand the effects of chemo and/or radiation. Chemo therapy uses large doses of strong anti- cancer drugs which kill cancer cells; the type of medication and the length of each chemo therapy session will be determined by your particular cancer diagnosis.
Radiation therapy uses intense beams of x-rays which are targeted directly and precisely at your cancer; some burning of the skin may occur and cause some discomfort and you may be extra tired during a schedule of radiation treatments. Radiation therapy will generally last for 5- 6 weeks and occur on several days of the week; again it will be individualized according to your particular cancer diagnosis.
If you have any questions or are unclear about the cancer treatments your physician has recommended; ask you physician to explain until you do understand. It is specially important with a diagnosis of cancer that you clearly understand all your treatment options, the possible side effects, and the prognosis for your cancer.
Cancer Treatment Side Effects...
When people think of cancer treatment the first thing they usually think of is the nausea and hair loss that often accompanies chemo therapy and radiation treatments. Today treatment medications have been improved making treatments more bearable and better medications are available for side effects such as nausea.
Cancer will cause a loss of appetite in most patients; once cancer treatments begin your appetite may be non- existent. It is vital to your recovery for you to eat! If loss of appetite is a problem, discuss it with your physician; medication may sometimes be prescribed to increase your appetite. Patients are often advised to drink a nutritional supplement such as, Ensure. Many cancer patients mix a nutritional supplement with ice cream and make a nutritional milk shake. If eating is impossible, feeding tubes may be inserted, but they are used only as a last resort and when use may mean the difference between life and death. Remember many types of cancer are survivable, but almost all cancer patients will lose their appetite; so the use of feeding tubes to deliver nutrition, if food cannot be tolerated may save your life.
If you are the family or friend of a cancer patient who does not want to eat, encourage them to eat as much as possible. Cancer patients taste buds are often affected by the treatments they receive; foods they once loved may not taste good anymore and they may request some unusual foods. No matter what they request, the most important thing is that patients eat!
Talking With Your Physician...
Good communication between you and your physician is of particular importance during this time. Your physician will explain the possible surgery and/or biopsy procedures best for your particular suspected cancer diagnosis. It is extremely important for you to listen carefully to your physician as he explains your options to you. If you do not understand something ask questions until you do!
It is always your option to choose to have a second opinion and your physician should have no problem with this; often he will have a partner or another colleague whom he will refer you to. Or you can choose your own second opinion physician. Remember when faced with a possible cancer diagnosis; early diagnosis and treatment is imperative to survival.
The good news about cancer is that for many types of cancer survival rates have risen significantly, in the last few years. This is due, in large part, to early cancer diagnosis and treatment.
