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What is a needle aspiration biopsy?
A fine needle aspiration biopsy can help your doctor identify the cause of an abnormal lump, mass, or lesion in your body. It is used in the diagnosis of breast, liver, and prostate disorders, as well as lung disease and liver tissue disease. The most common sites that are biopsied include the breast, thyroid, kidney, lung, lymph nodes, liver or abdominal masses with CT guidance.
During this procedure, thin needles are inserted into a mass or lump, usually under X-ray guidance, to extract cells that will be examined under a microscope. A needle aspiration biopsy is safer and less traumatic to your body than an open surgical biopsy.
Why would I need this procedure?
If you have an unexplained lump or abnormal mass, your doctor may suggest this type of biopsy. This is done first to establish a diagnosis so treatments can be better planned. It is also used as a follow-up examination after treatment for certain disorders.
How do I prepare for a needle biopsy?
You may be told to restrict food and fluids for a certain period of time before the test depending on the area biopsied. Breast fine needle aspirations (FNA) can be done at any time and have no restrictions. Pretest studies, such as routine blood work and urine tests, may be required. If you are taking any medications (prescription or over-the-counter), especially aspirin or blood thinners, it is important to inform your doctor before you have this exam. Certain medications can affect your bleeding time and may need to be stopped for several days before this test. Aspirin needs to be stopped one week before the procedure.
For simple skin, breast or palpable lumps or lymph nodes, the procedure takes five minutes and often the results are readily available at the time of the procedure depending on the skill and experience of the cytopatholgist.
What happens during the biopsy?
After you change into a hospital gown, vital signs (pulse, blood pressure) will be taken. Depending on the nature of the biopsy, an intravenous line (IV) may be placed in a vein in your arm. Medications to help decrease anxiety are often given by mouth or directly into your intravenous line before the biopsy is obtained.
You will be positioned so that the pathologist or radiologist has easy access to the area to be biopsied. The skin will be swabbed with an antiseptic solution, and you will receive a local anesthetic so you feel little pain.
An X-ray of the area will be done as needed before and, sometimes, during the biopsy. After the mass is located, the doctor inserts a needle into it and withdraws a specimen of cells that are then sent to the lab. It is not uncommon to have multiple needles inserted. Several areas may need to be biopsied to ensure that samples from the suspicious area are obtained.
A lung biopsy, done in this manner, takes 30 minutes to 60 minutes. Breast and prostate needle biopsies take 30 minutes or less. A liver biopsy can take about 10 minutes to 15 minutes.
What happens after the biopsy?
A nurse will clean the skin around the biopsy site and may apply an adhesive bandage. If you feel pain, you may be given a pain reliever. Aspirin should not be taken for seven days before the procedure. Other pain medications like Motrin® or Naprosyn® should not be taken for 48 hours before the procedure. Neither aspirin nor the nonsteroidal anti-inflammatory medications (Motrin or Naprosyn) should be taken for 48 hours after the procedure because they can increase the risk of bleeding following the biopsy. If you are taking aspirin for a cardiac or a neurological condition, check with the prescribing doctor before stopping the medication.
You may feel some mild discomfort or throbbing and see some bruising at the site where the needle was inserted. Patients who have had a lung biopsy may cough up small amounts of blood. Kidney biopsy patients may notice some mildly blood-tinged urine. This is normal and should not cause undue concern.
Your doctor will give you specific instructions about diet, activity limitations, and follow-up appointments. In general, contact your doctor if the following signs or symptoms occur:
- Extensive bleeding from the biopsy site
- Fainting, lightheadedness or passing out
- Heart pain
- Chest pain or palpitations
- Progressive swelling
- Formation of a mass you can feel near the biopsy site
- Increasing pain which is not relieved by medicine such as Tylenol
- Any breathing problems
- Fever
What are the risks?
Bleeding is the most common complication of this procedure. A slight bruise also may appear at the site of the biopsy. If a lung or kidney biopsy has been performed, it is very common to see a small amount of blood in sputum or urine afterward. Only a small amount of bleeding should occur.
Other complications depend upon the area biopsied. Lung biopsies sometimes cause a collapsed lung. This complication also can accompany biopsies in the upper abdomen near the base of the lung. About one quarter to one half of patients having lung biopsies may develop a small lung collapse. If there is a large lung collapse, it is treated successfully with a chest tube and suction in the hospital.
For biopsies of the liver, bile leakages and/or liver hematomas may occur, but these are quite rare. Pancreatitis (inflammation of the pancreas) may occur after biopsies in the area around the pancreas. Pain and infection may occur after a biopsy.
Deaths have been reported from internal (abdominal or chest) needle aspiration biopsies, but their occurrence is extremely rare. Your doctor is the best person to explain the risks and benefits associated with the type of biopsy that you undergo.
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External Sources
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National Institutes of Health, Warren Grant Magnuson Clinical Center
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Women's Health Information Center, The Journal of the American Medical Association
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Women's Information Network Against Breast Cancer
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Dollinger M, Rosenbaum, EH, Tempero M., et al. Everyone's Guide to Cancer Therapy, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2002
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This article was reviewed and updated June 2007.
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