Answers to questions for our FNA biopsy patients

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What is FNA?

Your health care practitioner has referred you to us for Fine Needle Aspiration (FNA). FNA is a quick, comfortable and reliable method of sampling virtually any lump which can be felt or visualized on ultrasound, often eliminating the need for a surgical biopsy. The biopsy is simple, requiring an appointment of only 10-15 minutes. Nevertheless, our years of experience have taught us that most patients have a question or two regarding the procedure. Thus, we have prepared these answers to FAQs in keeping with our belief that truthful answers are the best way to stop anxiety. We urge you to take a few minutes to read these carefully. Then write down any other questions you may have and bring them with you to your appointment.

What is the history of FNA?

Over the past two decades FNA has been increasingly valued as a way to diagnosis lumps of virtually all causes. Previously, a patient and physician had to choose between the simple, but possibly unreliable process of observation versus the complexity but greater accuracy of surgery. Now, instead of needing surgery to obtain tissue, FNA uses a tiny needle to remove minute fragments of tissue while leaving the lump unchanged. These fragments are spread onto glass slides and examined under a microscope. Preparation and interpretation techniques used to evaluate the samples have been refined recently. In fact, Drs. Abele, Mathios, Egerter, and Bardales have contributed to both the medical literature and physician training in this field over the past decades, including teaching a number of national courses.

What is the purpose of performing an FNA?

Once either you or your health care provider feel a lump in your body, important questions arise. This lump can be the result of an unknown injury such as scar tissue, a cyst, an infection, a tumor, and so on. Although many indirect tests such as x-rays and laboratory studies can be helpful, these usually are not sufficient to determine what treatment is needed. Depending upon the exact diagnosis of your lump, the treatment possibilities range from doing nothing other than watching it, to having it surgically removed.

What is involved in the FNA procedure?

First we ask you several questions about your lump: where it is located, when you or your doctor first noticed it, and have there been any changes in it? It is also important to know what might have caused the lump, such as trauma or infection. Next, we review x-rays or other reports which you or your doctor might provide. Finally, we ask if you have any questions about the biopsy.
Your physician will be either Dr. Abele, Egerter, Bardales, Wilton or Zhou. The examination begins by feeling (palpation of) the lump. The overlying skin of the lump is outlined with a special ink, which you can wash off later. The size of the lump is measured and the location is noted so that you and your physician can be sure exactly what area was sampled.

Sometimes our doctor will use our ultrasound imaging machine to gather additional information about your lump and to assist in directing the biopsy needle.

Our doctor numbs the skin over the lump by injecting a few drops of a mild anesthetic. During the few seconds it takes to inject this medication, some patients note a brief tingling or burning sensation in the skin. Both the needle size and amount of medication we use are smaller than what a dentist would use to numb a tooth and most patients note less discomfort. In performing over 25,000 of these anesthetic injection, no significant complications have been encountered. Nonetheless, if you have had a reaction to anesthetic in the past, please discuss this with our doctor. Rarely, the injection may cause a small area of bruising in the skin which lasts a few days to weeks.

The actual biopsy is brief, lasting only a few seconds. The biopsy needle, smaller than that used to draw blood from your arm, is gently inserted through the numbed skin and into your lump for one or two seconds. That’s it! Usually, we take about four samples of the lump. This assures you and your physician that the specimen obtained is reasonably representative.

During the biopsy, most patients experience a vague sense of pressure, which is not painful due to the anesthetic. Relaxing after the first sample, many have commented, “is that all there is to this?!”

We use the smallest needles possible to obtain a reliable biopsy. Bleeding is minimal, and consists of a few drops of fluid from the needle site. The nurse will place a small adhesive strip over any skin puncture to protect your clothing. You may remove the strip at any time. You are free to return to work, or resume any other activity you wish. Please continue to take all prescribed medications as usual since the biopsy will not affect these.

What are the possible complications?

Fine needle aspiration biopsy by an experienced practitioner is virtually free of significant complications. The most common complication, which occurs in only about on quarter of our patients, is bruising or tenderness in the area of the biopsy. In our experience this is mild, requires no specific medical attention, and disappears within a few days. Some patients note that an ice pack or mild non-aspirin medication (such a Tylenol) helps. Complications such as rapid swelling, bleeding or infection are extraordinarily rare. If these or any unusual symptoms occur, please call your doctor or our office immediately.
Even though the risk of a significant complication is small, every medical procedure does have a small risk. However, there is also a risk in choosing just to watch a lump without a biopsy.

Occasionally, after talking with and examining you, we may feel the procedure would not benefit you. In that case, a written report describing our findings and an explanation of why we did not perform the biopsy will be sent to your physician. Naturally, our fee for an examination without biopsy is less than for examination with biopsy.

Will the biopsy make the tumor spread?

Some patients have expressed concern that the biopsy might cause a tumor to spread. many studies have shown that this risk is minute. Hundreds of thousands of needle biopsies have been performed worldwide, and only about two dozen instances of tumor spreading as a consequence of the biopsy have been reported.

How are the FNA results obtained?

We have found that FNA results are more accurate when the doctor who performed the biopsy also interprets the sample. The OPA doctor who performed your biopsy will personally examine your slides and determine the diagnosis. In all cases, we phone the results of this test to your physician by 3 P.M. the following work day. We also mail a written report to your doctor’s office. If you wish to know the results of your biopsy before your next scheduled appointment, contact your doctor directly. He can best explain exactly what the test results mean for you and what, if anything, should be done next. However, if you are unable to reach your doctor, please call our office (916-444-0889).

What are the goals of FNA?

Our goal is to determine the cause of your lump, which we can do in about 92% of cases. For another 7% of cases, we can usually narrow the cause of the lump to two or three likely possibilities. In only about 1% of cases is the sample too limited to help your doctor.
For either of these last two cases, your doctor might recommend a repeat FNA, a surgical biopsy, or other tests to further investigate the nature of your lump.

Despite our experience of over 64,000 cases and the care we devote to each case, no procedure is 100% accurate. In our experience, the chance of your FNA failing to find a malignancy when it is present is 3-5%. Thus, neither patient nor physician should take a benign diagnosis as an indication to forget your lump. Instead, you should continue in your doctor’s care so that both of you can watch your lump. If it enlarges, it is imperative that either we resample it or it be surgically removed, as these changes may indicate an underlying malignancy not identified by the test.

Although rare, there are times when we cannot feel the nodule to be biopsied because of its depth, position or texture. If the nodule cannot be felt, we cannot do the procedure. If this happens, we will discuss it with your doctor who can then best advise you on alternate tests that may be necessary. It is important to seek your original doctor’s advice because one’s inability to feel a lump does not necessarily rule out malignancy.

Are you thinking of not coming in?

Although most patients look upon FNA much as they would a blood test, some patients put off scheduling the biopsy, or fail to keep an appointment, for a variety of reasons. These include fear of needles and a fear of what the biopsy might find. Rather than risk delay in your diagnosis, we urge you to make and keep your appointment with us. In the meantime, write down your questions so you won’t forget them. Then, come in to see us. You have our absolute assurance that we will give you honest, straight answers, and that we have a duty to provide them to you.
If you still do not desire the biopsy after this discussion, we will respect your decision and you will be free to leave. We will not pressure you into having a biopsy you do not want. Later, if you change your mind, we will gladly reschedule your appointment.

Who will I be seeing?

Fine needle aspiration biopsy is a specialty of Outpatient Pathology Associates (OPA) Our full attention is devoted to the particular needs of patients receiving biopsies outside of the hospital. Prior to offering this service in Sacramento in 1982, Drs. Abele and Mathios spent a total of six years on the faculty of the University of California, San Francisco. Dr. Egerter did extensive training in FNA at the University of California, San Francisco and the Karolinska Hospital in Sweden. Dr. Bardales most recently was on the faculty at the University of Minnesota. Drs. Abele and Egerter continue as members of the clinical faculty at the University of California, San Francisco.

Our FNA biopsy service is the largest such practice that we know of in the western United States. Our experience is an important consideration in your physician’s decision to refer you to us. Our goal is to provide the highest level of professional care while maintaining an environment sensitive to your personal needs. We strive to make your biopsy an easy experience.