Michael Cohen, MD
Department of Pathology
University of Iowa Hospitals and Clinics

First Published: April 2000
Last Revised: April 2000
Peer Review Status: Internally Peer Reviewed

Fine needle aspiration is a very useful technique to evaluate a variety of lumps and bumps. Because of its safety, cost-effectiveness and accuracy, it is often the first biopsy procedure of choice in evaluating a variety of different masses.

Who is an ideal candidate for this procedure?

Basically, all patients are potential candidates for this procedure. The most common sites that are biopsied include the breast, thyroid, and lymph nodes (lymph glands).

What types of cancer are best found/evaluated with this procedure?

As you allude to, one of the major roles of this biopsy procedure is to diagnose cancer. One of the advantages of this biopsy procedure is that it is easily done in an outpatient setting. In addition, it is a safe, relatively inexpensive, and accurate procedure. Not all lumps/bumps are due to cancer. Thus, this biopsy procedure is particularly useful in distinguishing the nature of the lump, including cancer.

How does this procedure differ than more traditional means of biopsy?

This procedure differs from traditional biopsy in several ways. Most traditional biopsy procedures involve an incision in the skin. FNA utilizes a small needle to puncture the skin and obtain material, which is examined by a pathologist under the microscope.

What happens during this procedure/process?

The procedure as I mentioned before is generally done as an outpatient. Typically, after a discussion with the patient about the procedure and obtaining informed consent, the area to be biopsied is cleaned with antiseptic agents and a small needle is introduced into the mass. In most instances, several biopsies can be performed by FNA in order to sample different areas of the mass.

Is the fine needle biopsy anymore accurate than the other types?

As a rule, excisional biopsy (traditional biopsy) may be more accurate than FNA. However, FNA is much less invasive and in the majority of instances can give the same information. To put this in a slightly different way, in well-trained hands, FNA can obviate the need for conventional biopsy in many instances. This is particularly useful for non-palpable masses.

Are there any further risks associated with this procedure than with the more traditional procedures, or vice versa?

The risks of FNA are very minimal. They include some local bleeding and resultant tenderness, and rarely, infection. As a general rule, FNA is safer than traditional biopsy procedures, particularly for those that are only identified by x-rays (nonpalpable).

Where are Lymph nodes? Is it common for cancers to spread there, it seems as if I've heard that it is?

Lymph nodes are found throughout the body and are usually the first site of metastatic spread of cancers. For example, FNA could be particularly useful in patients with an established diagnoses of cancer who subsequently presents with enlargement of a lymph node(s). Yes, it is common for cancers to spread to lymph nodes.

How long does it take to get the results from a biopsy?

This is an excellent question. One of the advantages of FNA is that results can generally be obtained within 15-30 minutes after the procedure. Most traditional forms of biopsy take about 24 hours to get the final results. Therefore, depending on the specific clinical situation, the information provided by FNA may be used in determining the most appropriate form of treatment while the patient is still seeing his/her physician.

Do they normally numb the area to be biopsied? What is the recovery time?

This depends a little bit on who and what is being biopsied. In most instances, there is no need for anesthesia (numbing), especially for lumps and bumps that are felt underneath the skin. For deeper biopsies, some form of local anesthesia is used. The recovery time is relatively short.

Do patients have access to their reports?

Like all pathology reports, patients should have access to their reports. The usual way this is dealt with is by directly communicating with the physician of record.

What is a large core needle biopsy, and are they effective?

Large-core needle biopsies are a different way of biopsying masses. They differ from fine needle aspiration (FNA) in the diameter of the needle that is used. As a rule, large-core needle biopsies are significantly bigger than the fine needles. Therefore, the complications, which are still relatively minimal with a large-core needle, are greater. The most common complication is local bleeding. Large-core needles are effective ways of biopsying specific areas and are most commonly used for biopsying the breast, and the prostate.

Are there any age limitations about biopsying?

Basically, any person of any age can be biopsied using FNA. Even children can be biopsied using FNA. This is one of the nice aspects of this biopsy procedure.

What types of diseases can be diagnosed by FNA?

There are in fact a number of diseases and disease processes that can be diagnosed by FNA. While the diagnosis of cancer is clearly the most common, infectious/inflammatory processes can also be readily diagnosed. In some instances, FNA can be very useful in triaging patients for further evaluation in a rapid, accurate, and cost-effective manner.

What are the most common areas that are biopsied?

In most hospitals, the most commonly biopsied organ is the breast. FNA, particularly in conjunction with clinical examination and mammography, is very useful in evaluating breast masses. Breast masses are common, but only a small percentage of these, in fact, have cancer. One of the other commonly biopsied organs is the thyroid. Thyroid nodules are also common and are only rarely the result of the cancer. FNA is also very useful in deciding what the thyroid nodules are due to. Lymph node FNA is the third most common area. This is most commonly used to detect metastatic cancer. The two most common nonpalpable organs that are biopsied are the liver and the lung. In these organs, the most common question is whether a nodule identified by x-ray is cancerous or not.

What are symptoms that a biopsy is needed? What if I do not feel a lump? Is it normal for a doc to find and recommend a biopsy without me being suspicious?

The most usual indication for a biopsy is a lump. In only specific organs is a biopsy recommended without there being an identifiable lump.

Who performs FNA procedure?

This depends on the hospital and clinical situation. In hospitals such as where I work, the pathologist performs the FNA of palpable masses. In other hospitals, it may be the surgeon, internist, or family physician that performs the FNA. In most hospitals, nonpalpable masses are biopsied by the radiologist.

What determines if something needs to be biopsied?

The answer to this question is highly individual. It will depend on things that include size of the lump, where it is, how long it has been present, etc. Most importantly, the physician seeing the patient determines this.