Dana Richards, MD
Director of Cytopathology

Kimberly Absher, MD
Derek Allison, MD
Therese Bocklage, MD
Julie Dueber, MD
Dava West-Piecoro, MD

 is a quick and reliable method of sampling almost any lump which can be felt, often eliminating the need and expense of surgical biopsy. It is a very simple procedure, requiring minutes to perform, while providing a diagnosis or significant clinical information in over 90% of cases. This brochure is designed to explain the procedure, answer the most frequent questions regarding it and relieve any anxiety which you may have.

OVER THE PAST 20 YEARS, fine needle aspiration biopsy (FNAB) has been increasingly used to diagnose lumps of all causes. Once a nodule or swelling is detected, some important questions arise that will determine how to manage it. It has been shown that FNAB usually provides the most important and the most cost effective information. Many indirect tests such as x-rays and lab tests, while useful, do not give a specific diagnosis.

THE LUMP MAY BE the result of a forgotten injury, a cyst, an infection, a benign growth or a malignant tumor (cancer). Before FNAB, physicians had to choose between observing the lump over time, risking under-diagnosis of cancer, and performing expensive and invasive surgery, which in many cases is not needed for benign conditions. Most importantly, diagnosis of a cancer before your operation leads to far better preparation allowing you to carefully consider the options before undergoing anesthesia.

WHILE THE PROCEDURE itself is quick, it is important for us to carefully acquaint ourselves with your problem. Where is the lump? How long has it been there? Are there any changes, or newer lesions appearing? Are you ill in other ways, (fever, weight loss) taking antibiotics, or have you ever had any type of cancer, even skin cancer? It is also important for us to review results of any recent blood tests or x-rays. Let us know about these.

THE INDIVIDUAL BIOPSY is brief, lasting only a few seconds. Instead of making an incision to obtain tissue, a thin needle (about one-third the width of that used to draw blood for lab tests) is placed into the lump beneath the skin, leaving it, in most cases, unchanged. If indicated, a few drops of anesthetic may be injected into the skin over the lump or an anesthetic cream may be placed on the skin. However, if the lump is large, the number of sticks and the discomfort of the anesthetic may be in excess of that from the FNAB itself.

DURING THE PROCEDURE, a vague sense of pressure is noted. Rarely there may be pain, but if that is the case you may let us know so that we may re-position the needle to a more comfortable location. Only a very rare case has had to be discontinued due to anxiety or pain. Most will comment after the first sample, “That wasn’t bad at all!” The lump must be thoroughly sampled to avoid misdiagnosis, so the sampling process is performed approximately 2-4 times. Be assured that we use the smallest needles and the fewest number of passes possible to make a diagnosis. After aspirating cells from the nodule, they are ejected as drops of fluid on glass slides and smeared out in a thin layer. The remainder is rinsed into a preservative fluid.

AFTER THE FNAB, firm pressure is applied to the area for several minutes to avoid excessive bruising. A small adhesive strip will be placed over the site if necessary to protect your clothing. You are free to return to work, home, go shopping (or any other activity) as you wish. You may bathe the area as you normally would. With neck aspirates, avoid heavy lifting or straining. Please continue to take all prescribed medication. 

COMPLICATIONS from the procedure are rare except for bruising or tenderness of the skin in the area of the biopsy. This is usually mild, requires no special treatment, and disappears in a few days. Some find an ice pack for 20 minutes and a non-aspirin containing pain-killer do well to relieve the minor pain. A rare patient may become dizzy, usually due to pressure on the nerves of the neck. This responds to resting and relief of pressure. Rapid swelling with pain, bleeding or infection are rare. If these occur, contact the clinic or your physician.

THE REPORT will in most cases be sent to your physician the next day. Occasionally we have to perform special studies on the cells. If you have not heard from your physician within the expected time, you may contact him/her. Your physician can best explain what, if anything, should be done next.

OUR GOAL is to find the cause of the lump which we can do in over 80% of cases. In another 10% we can narrow it to a few likely causes. Despite our experience, our training, and the care we devote to each case, you must realize that no procedure is 100% accurate. The chance that your FNAB will fail to find a cancer when one is present is 10% or less. Thus it is very important that you not take a benign or non-specific diagnosis as a reason to ignore your lump, especially if it is causing symptoms or growing. If so, it should be re-sampled or removed.