Needle aspiration biopsy (NAB), also known as fine needle aspiration cytology (FNAC), fine needle aspiration biopsy (FNAB) and fine needle aspiration (FNA), is a procedure performed to diagnose certain kinds of medical conditions, such as lumps in the neck. In this technique a thin needle is inserted into a mass or lump to extract cells that will be examined under a microscope. Fine needle aspiration biopsies are very safe, minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead. Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ... A microscope (Greek: (micron) = small + (skopein) = to look at) is an instrument for viewing objects that are too small to be seen by the naked or unaided eye. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ...

A needle aspiration biopsy is safer and less traumatic than an open surgical biopsy. Sometimes, surgery is needed to treat complications of a needle aspiration biopsy. But in such a case, the patient would have had to undergo a similar surgical procedure to obtain a diagnosis had the needle aspiration biopsy not been attempted.

Countries with the most developed aspiration biopsy are Sweden, Slovenia and India. At Karolinska hospital (Stockholm, Sweden), the annual volume averages eleven thousand aspirates; at Institute of Oncology (Ljubljana, Slovenia) ten thousand. Within the USA, the highest volume is encountered at MD Anderson (Houston, TX) with an annual volume of seven thousand aspirates.

Applications

This type of biopsy is performed for one of two reasons:

1. A biopsy is performed on a lump or mass when its nature is in question.
2. For known tumors, this biopsy is performed to assess the effect of treatment or to obtain tissue for special studies.

The biopsy is usually performed by a cytopathologist or a diagnostic radiologist, a doctor with special training in performing and interpreting x-ray procedures and in performing biopsies using x-ray guidance, with the assistance of a cytopathologist or a properly trained cytotechnologist. Radiology is the branch of medical science dealing with the medical use of x-ray machines or other such radiation devices. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. ...

Preparation

During this procedure, a very thin needle is used to remove cells or other material from a tumor or mass detected in the body. These cells are spread on a glass slide, stained and observed under the microscope by the cytopathologist, who will attempt to make a diagnosis. There may be times when a diagnosis cannot be made; not all cells removed during a needle aspiration biopsy can be identified with certainty. Tumor (American English) or tumour (British English) originally means swelling, and is sometimes still used with that meaning. ...

Several preparations are necessary before this procedure.

• Suspension of intake of aspirin or aspirin substitutes (e.g. ibuprofen, naproxen) for one week before the procedure;
• Suspension of food intake a few hours before the procedure;
• Routine blood tests, including clotting profile) must be completed two weeks before the biopsy;
• Suspension of blood anticoagulants medications;
• Antibiotics prophylaxis may be instituted.

Before the procedure is started, vital signs (pulse, blood pressure, temperature, etc.) are taken. Then, depending on the nature of the biopsy, an intravenous line (I.V.) may be placed. Very anxious patients may want to be given sedation through this line. For patients with less anxiety, oral medication (Valium) can be prescribed to take before the procedure. Aspirin or acetylsalicylic acid (acetosal) is a drug in the family of salicylates, often used as an analgesic (against minor pains and aches), antipyretic (against fever), and anti-inflammatory. ... Ibuprofen (INN) (IPA: ) is a non-steroidal anti-inflammatory drug (NSAID) widely marketed under various trademarks including Herron Blue, Act-3, Advil, Brufen, Motrin, Nuprin, Dorival and Nurofen. ... Naproxen (trade names: Aleve, Anaprox, Naprogesic, Naprosyn, Naprelan) is a non-steroidal anti-inflammatory drug (NSAID) commonly used for the reduction of mild to moderate pain, fever, inflammation and stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, injury, menstrual cramps, tendinitis, bursitis, and the... Coagulation is the thickening or congealing of any liquid into solid clots. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Prophylaxis refers to any medical or public health procedure whose purpose is to prevent, rather than treat or cure, disease. ... In medicine, a persons pulse is the throbbing of their arteries as an effect of the heart beat. ... A sphygmomanometer, a device used for measuring blood pressure. ... Fig. ... Anxiety is an pleasant complex combination of emotions that includes fear, apprehension and worry, and is often accompanied by physical sensations such as palpitations, nausea, chest pain and/or shortness of breath. ... Diazepam, brand names: Valium, Seduxen, in Europe Apozepam, is a 1,4-benzodiazepine derivative, which possesses anxiolytic, anticonvulsant, sedative and skeletal muscle relaxant properties. ...

Procedure

The skin above the area to be biopsied is swabbed with an antiseptic solution and draped with sterile surgical towels. The skin, underlying fat, and muscle is then numbed with a local anesthetic. After locating the mass for biopsy, using x-rays or palpation, a special needle of very fine diameter is passed through into the mass. The needle may be inserted and withdrawn several times. There are many reasons for this: In zootomy and dermatology, skin is an organ of the integumentary system made up of multiple layers of epithelial tissues that guard underlying muscles and organs. ... An antiseptic solution of iodine applied to a cut An antiseptic (Greek αντι, against, and σηπτικος, putrefactive) is a substance that prevents the growth and reproduction of various microorganisms (such as bacteria, fungi, protozoa, and viruses). ... Adipose tissue is an anatomical term for loose connective tissue composed of adipocytes. ... It has been suggested that this article or section be merged into Muscular system. ... A local anesthetic is a drug that reversibly inhibits the propagation of signals along nerves. ... Palpation is a method of examination in which the examiner feels the size or shape or firmness or location of something (of body parts when the examiner is a health professional). ...

• One needle may be used as a guide, with the other needles placed along it to achieve a more precise position.
• Sometimes, several passes may be needed to obtain enough cells for the intricate tests which the cytopathologists perform.
• When the mass is small, several passes may be necessary to position properly the needle tip.

After the needles are placed into the mass, cells are withdrawn by aspiration with a syringe and spread on a glass slide. The patient's vital signs are taken again, and the patient is removed to an observation area for about 3 to 5 hours. A syringe consists of a plunger fitted to a tube, called the barrel, which has a small opening on one end. ...

Post-operative care and complications

As with any surgical procedure, complications are possible. Fortunately, major complications due to thin needle aspiration biopsies are fairly uncommon, and when complications do occur, they are generally mild. The kind and severity of complications depend on the organs from which a biopsy is taken or the organs gone through to obtain cells.

After the procedure, mild analgesics are used to control post-operative pain. Aspirin or aspirin substitutes should not be taken for 48 hours after the procedure (unless aspirin is prescribed for a cardiac or neurological condition). Since sterility is maintained throughout the procedure, infection is rare. But should an infection occur, it will be treated with antibiotics. Bleeding is the most common complication of this procedure. A slight bruise may also appear. If a lung or kidney biopsy has been performed, it is very common to see a small amount of blood in sputum or urine after the procedure. Only a small amount of bleeding should occur. During the observation period after the procedure, bleeding should decrease over time. If more bleeding occurs, this will be monitored until it subsides. Rarely, major surgery will be necessary to stop the bleeding. An infection is the detrimental colonization of a host organism by a foreign species. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Minor traumatic bleeding from the head Bleeding is the loss of blood from the body. ... The lungs flank the heart and great vessels in the chest cavity. ... The kidneys are bean-shaped excretory organs in vertebrates. ... Sputum is matter that is coughed up from the respiratory tract, such as mucus or phlegm, mixed with saliva and then expectorated from the mouth. ... This article or section is in need of attention from an expert on the subject. ...

One study shows that needle biopsies may increase the likelihood that cancer will spread, if indeed the tumor is malignant. http://bmj.bmjjournals.com/cgi/content/full/328/7438/507

Other complications depend upon the body part on which the biopsy takes place:

• Lung biopsies are frequently complicated by pneumothorax (collapsed lung). This complication can also accompany biopsies in the upper abdomen near the base of the lung. About one-quarter to one-half of patients having lung biopsies will develop pneumothorax. Usually, the degree of collapse is small and resolves on its own without treatment. A small percentage of patients will develop a pneumothorax serious enough to require hospitalization and placement of a chest tube for treatment. Although it is impossible to predict in whom this will occur, collapsed lungs are more frequent and more serious in patients with severe emphysema and in patients in whom the biopsy is difficult to perform.

• For biopsies of the liver, bile leakages may occur, but these are quite rare.

• Pancreatitis (inflammation of the pancreas) may occur after biopsies in the area around the pancreas.

• Deaths have been reported from needle aspiration biopsies, but such outcomes are extremely rare.

Left-sided pneumothorax (on the right side of the image) on CT scan of the chest with chest tube in place. ... The abdomen is a part of the body. ... The liver is an organ in some animals, including mammals (and therefore humans), birds, and reptiles. ... Bile (or gall) is a bitter, greenish-yellow alkaline fluid secreted by hepatocytes from the liver of most vertebrates. ... Pancreatitis is inflammation of the pancreas. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... For the song by Weird Al Yankovic, see Pancreas (song) The pancreas is an organ in the digestive and endocrine system that serves two major functions: exocrine (producing pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin). ...

Source

• Adapted from Preparing for Needle Aspiration Biopsy. Public domain text of the National Institutes of Health Warren Magnuson Grant Clinical Center.

The National Institutes of Health (NIH) is the primary agency of the United States government responsible for medical research. ...

External links

Breast

• GPnotebook -462749619 - "fine needle aspiration cytology (breast)"
• FPnotebook GYN150 - "Breast Cyst Aspiration"

GPnotebook is a British medical database for general practitioners (GPs. ... The Family Practice Notebook is a medical database focused on family practice. ...

Lung

• MedlinePlus Encyclopedia 003860 - "Lung needle biopsy"

MedlinePlus (medlineplus. ...

Neck

• eMedicine ent/561 - "Fine-Needle Aspiration of Neck Masses"
• MedlinePlus Encyclopedia 003899 - "Thyroid nodule fine needle aspirate"

eMedicine is an online clinical medical knowledge base that was founded in 1996. ... MedlinePlus (medlineplus. ...

Bone

• MedlinePlus Encyclopedia 003658 - "Bone marrow aspiration"
• FPnotebook HEM212 - "Bone Marrow Aspiration"
• eMedicine med/2971 - "Bone Marrow Aspiration and Biopsy"