Fine Needle Aspiration Biopsy

Fine needle aspiration biopsies, also called fine needle biopsies, are tests that allow doctors to analyze tissues for the presence of cancer. They are often used after imaging scans, but before additional tissue tests, as part of a comprehensive diagnostic process for mesothelioma.

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Fine needle biopsies are less invasive than other diagnostic procedures, such as surgical biopsies or core biopsies. A fine needle aspiration takes only a few minutes, and provides a segment of cells for laboratory workers (called cytopathologists) to study under a microscope.

Oncologists may order a fine needle biopsy if an imaging scan shows a mass on the pleura or peritoneum, or if they suspect mesothelioma or another asbestos-related disease. However, they may choose other types of biopsies if the tumors are deep inside the body. Regardless of the type of biopsy used, the purpose is to test the cells for characteristics that represent malignant mesothelioma.

The Process

Fine needle biopsies are relatively simple. A doctor inserts a long, thin hollow needle directly into the suspicious mass, then draws a small section of tissue through the needle. In some cases (such as when the tumor is not directly under the skin), doctors use imaging techniques to guide the needle. These imaging techniques are especially helpful when doctors attempt to diagnose thoracic cancers with a fine needle aspiration.

Fast Fact: Patients who take aspirin, Plavix, warfarin or another blood thinner should ask their doctor about discontinuing the medicine a few days before their fine needle aspiration.

The process is not painful, although some patients feel a slight prick during insertion. Many patients opt for numbing cream to prevent discomfort. Complications are extremely rare, but can include infection or bleeding at the incision site. Fine needle aspirations are less likely than other biopsies to cause severe complications, like a collapsed lung.

Most doctors can perform this procedure in their office. Patients can go home a few minutes after the biopsy, and most receive their results within two or three days.

Using Fine Needle Aspirations to Diagnose Mesothelioma

The diagnostic accuracy of fine needle aspirations depends on several factors, including the size of the growth and the type of the mesothelioma cells. Fine needle biopsies can be definitive enough to officially diagnose malignant mesothelioma. However, most doctors order additional tests, such as a surgical biopsy, to determine the cell type and other prognosis-related features.

In some cases, cytopathologists extract molecules called RNA (ribonucleic acid) from fine needle biopsy samples. They then perform molecular tests on the RNA to increase the likelihood of arriving at an accurate mesothelioma diagnosis.

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Procedure Is Common When Testing for Cancer

The advantages of fine needle biopsies are simplicity and low cost. They also can lead to earlier diagnosis, which is crucial in the treatment of mesothelioma and most other cancers. An early diagnosis typically gives a patient more treatment options and better results.

Fast Fact: One study paired fine needle aspirations with genetically based molecular tests. The combination correctly identified 100 percent of malignant pleural mesothelioma cases.

A fine needle aspiration commonly is used to detect breast cancer, allowing a doctor to remove cells from a suspicious lump in the breast. It is a quick way for a doctor to sample a lump that was felt during a clinical breast exam. The procedure is easier than the common core needle biopsy and reduces the chance of any infection or bruising.

There are times when results from a fine needle biopsy are not conclusive with many cancers, even when a skilled specialist is involved.

The results typically are grouped into four categories:

  • Clearly benign: No sign of cancer
  • Clearly malignant: Definitively cancer
  • Less clear: Nondefinitive indication of cancer
  • Inadequate or insufficient: Sample not adequate to confirm a diagnosis

If the result is a clearly negative diagnosis, it typically will not involve a more invasive procedure. A nondefinitive result often will be followed with a more aggressive biopsy.

Downside of Fine Needle Aspiration

With certain cancers, doctors may be unable to make a definitive diagnosis from cell samples obtained in fine needle aspirations. While it is considered an important diagnostic tool, a fine needle aspiration may limit the preoperative evaluation of cancer patients.

A 2013 study published in the Endocrine Practice journal showed that just 45.7 percent of 245 patients with medullary thyroid cancer received a definitive diagnosis from a fine needle aspiration. The authors believe the majority of those patients did not receive an optimal evaluation.

Additional Resources

  1. American Academy of Otolaryngology – Head and Neck Surgery. Fine Needle Aspiration. (October 2011). Retrieved from entnet.org/HealthInformation/fineNeedleAspiration.cfm
  2. De Rienzo, A. Dong, L., Yeap, B. Y., Jensen, R., Richards, W. G., Gordon, G. J., Sugarbaker, D. J., & Buenom R. (2011). Fine needle aspiration biopsies for gene expression ratio-based diagnostic and prognostic tests in malignant pleural mesothelioma. Clinical Cancer Research; 17 (2). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21088255
  3. Roskell, D. & Buley, I. (2004, July 31). Fine Needle Aspiration Cytology in Cancer Diagnosis. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC498011/
  4. Susan G. Komen Breast Cancer Foundation, Fine Needle Aspiration. Retrieved from : http://ww5.komen.org/BreastCancer/FineNeedleBiopsy.html
  5. Essig, Garth, Porter, Kyle, Schneider, David, Debora, Arpaia, Lindsey, Susan. (2013, June 11). American Association of Clinical Endocrinologists, Endocrine Practice Journal. Retrieved from: http://journals.aace.com/doi/abs/10.4158/EP13143.OR

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