Fine Needle Aspiration Cytology or Biopsy

Fine-needle aspiration (FNA) can be performed in the office with minimal equipment for diagnosis of a discrete, solid breast mass. FNA testing results in a sensitivity of 90% and a false-negative rate of 3% to 10% in experienced hands (Valea and Katz, 2007). Contraindications include an overlying skin infection, underlying pulsatile mass, and a history of bleeding disorders.

The patient is properly given informed consent. She is recumbent in position, and the area of puncture is identified, marked, and cleansed. A local injection of 1 to 2 mL of anesthetic is infiltrated into the skin over the mass. The mass is stabilized with the three-finger technique previously mentioned. A 10- to 20-mL syringe with 18- to 22-guage needle attached is advanced into the mass. Full aspiration suction is performed, and the needle is passed through the mass in different planes three to five times for an adequate sample. The suction is released and the needle removed. The cell sample, frequently only in the needle itself, is placed on a cytology slide and fixed for proper pathologic assessment.

FNA provides histologic diagnosis but cannot determine architectural features. FNA should not be used to investigate microcalcifications, and it cannot distinguish ductal carcinoma in situ from invasive cancer. A core or open biopsy should be performed in these patients for more definitive diagnosis before excision or definitive treatment. (See Tuggy Video: Needle Aspiration.)

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