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Lump Biopsies: How to Get Accurate Results with Fine Needle Aspiration


Celina Nadelman MD



Dr. Celina Nadelman, MD is a board certified cytopathologist, which is a unique kind of pathologist. Her area of expertise is in fine needle aspiration (FNA), which is a biopsy done by a very small needle. Pathologists are not the only doctors who perform fine needle aspiration biopsies. For instance, an ENT, endocrinologist, surgeon or a radiologist could perform the same biopsy. However, these doctors are not trained to read the slide under the microscope, and thus, cannot make the diagnosis.

Finding a lump or bump in an area like the thyroid gland or breast is certainly a matter for concern. Once discovered, the paramount issue is to identify any abnormal tissue and make a diagnosis so treatment can be initiated as soon as possible. The diagnosis may be made using fine needle aspiration, a core biopsy or a surgical biopsy, often in combination with ultrasound or guided imaging to pinpoint a lesion’s location.


What is FNA?

Fine needle aspiration (FNA) biopsies are a safe, rapid, minimally invasive procedure for the diagnosis of superficial masses. The indication for doing a fine needle aspiration biopsy is to diagnose superficial masses in the thyroid, head and neck, salivary glands, lymph nodes, breasts, extremities or trunk. It is often the fastest, easiest test for malignancy, while being minimally invasive and cost effective. Although physical exam and imaging studies (ultrasound) can help identify a nodule, a tissue sample or biopsy is needed to see if the nodule is cancerous or not.


How it Works

An FNA specialist performs the outpatient procedure which consists of performing an ultrasound of the lesion in question, cleaning and marking the area, injecting a certain amount of local anesthesia and then performing the biopsy, using just the needle (also known as the Zeidela or French technique) in a sawing motion, in and out quickly. That dislodges the cells from the mass which can then be spread on slides for examination under a microscope. 


Once finished, the sight is wiped clean and covered with a small adhesive bandage, and the patient is helped to a sitting position. Post-care includes applying ice for swelling and keeping the area dry and clean for 12 hours. 


FNAs are performed for multiple reasons including tissue diagnosis, preoperative planning for malignancies, confirming benignity of low risk lesions and tissue for special studies such as molecular studies. The procedure offers patients an alternative to the dangers and cost of unnecessary surgery, while still finding out if the mass is benign or not. 


FNA Specialists who are also Pathologists 

When FNA specialists also act as pathologists, the specialist is not only performing the biopsy, but they are also the doctor who looks at your tissue under a microscope to make the diagnosis. These doctors can even look under the microscope during a procedure to make sure there is enough tissue to make an accurate diagnosis. This step eliminates the burden of having patients return for an additional biopsy. Additionally, this kind of quick analysis helps doctors determine if other types of ancillary studies on the biopsy material are needed such as Afirma (thyroid gene expression classifier), flow cytometry (for lymph nodes), immunohistochemistry, cytogenetics or microbiological culture.  


If an FNA specialist is only capable of doing a biopsy procedure, the sample slides musts be sent to a pathologist in a laboratory for analysis. In this situation, it takes longer to get your results, and often times the pathologist does not receive enough tissue to assess. When FNA physicians are also pathologists, they have the ability to give you a preliminary diagnosis immediately following the biopsy or by providing results to your doctor within 24 hours. Therefore, as a seamless experience, and a sort of one-stop shop, an FNA specialist who is also a pathologist will see the patient, retrieve a sample and make the final diagnosis all in one office visit. This can simplify and speed up the entire diagnosis process, offering you a quicker turnaround that can lower your anxiety and help you get the treatment you need faster. 

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