Fine
Needle Aspiration
Fine needle aspiration (FNA) of the breast is performed by inserting
a small-gauge needle attached to a syringe into a cystic breast
lesion and extracting any fluid within the cyst. (Dawson)
Used most commonly in young women with palpable breast lesions likely
to be benign cysts, FNA can serve both diagnostic and therapeutic
purposes. (Bell) If the FNA yields
clear fluid, and the lesion becomes nonpalpable, you may safely
conclude that the lesion was a benign cyst and instruct your patient
to return as needed should the cyst recur. If the extracted fluid
is not clear, or the lesion remains palpable after the procedure,
biopsy is indicated. This section addresses the first situation.
- Getting ready
- How to do it
- Follow up
As with any minimally invasive biopsy technique, the potential
exists for false-negative results when the needle fails to sample
the lesion (Kreuzer, O'Malley).
False-negative results can be minimized by using an imaging modality
for guidance in placing the needle. Failure to aspirate an adequate
sample may also lead to inadequate or misleading results. For these
reasons, FNA for cytology or histology examination is usually done
by specialists who have considerable experience with FNA techniques
(Cohen). FNA for drainage of
a simple cyst, however, is a straight forward procedure that does
not require special equipment or advanced training.
Getting ready
Assemble the following equipment:
- nonsterile gloves
- alcohol swabs
- sterile gauze pads
- clear hub needle—size and length of the needle are determined
by the size of the lesion and its estimated depth. Recommended
needle sizes include:
- 1-inch 22-gauge
- 1.5-inch 22-gauge
- 1-inch 23 gauge or 25 gauge
- A disposable 10-mL syringe with a Luer-Lok tip
- Ethyl chloride spray (or an ice cube) for topical anesthesia
Review any mammograms or other radiologic studies available. Discuss
the risks of the procedure (minor discomfort, bleeding, infection)
with the patient and obtain informed consent.
How to do it
Put on the gloves and prepare the needle and syringe. Localize the
lesion between the thumb and second finger of your non-dominant
hand. Clean the site with an alcohol swab, then either dry it with
gauze or allow the alcohol to evaporate. To achieve local anesthesia,
spray the site with ethyl chloride until the skin changes color
slightly. You must now work quickly since the anesthetic effect
is short-lived.
Continuing to use your non-dominant hand to stabilize the tissue,
take the needle and syringe in your dominant hand and aim them toward
the identified tissue. Advance the needle in a direction perpendicular
to the patient's skin. As soon as you feel the needle entering the
patient's skin, begin to pull back on the syringe. Continue pulling
back on the syringe as you continue advancing the needle.
You may identify an actual "popping" sensation as the needle enters
the cyst. Continue aspirating: fluid may now be entering the syringe.
You may, however, encounter this "popping" sensation but drain no
fluid: it is speculated that in such cases, the cyst fluid has drained
internally. Continue aspirating until you feel that you have drained
all of the cyst's fluid. Once you have completed the aspiration,
release the suction before withdrawing the needle from the lesion.
Upon completely withdrawing the needle, apply pressure at the puncture
site.
If no fluid enters the syringe, pull the needle back to just beneath
the patient's skin, then redirect it. Attempt to re-direct the needle
two or three times. When you have located the cyst, continue aspirating
until no additional fluid enters the syringe. If the fluid becomes
bloody, stop the procedure immediately and send any aspirated fluid
for cytology.
Follow up
In most cases, FNA will eliminate any symptoms (pain or discomfort)
your patient may be experiencing as a result of the breast cyst.
When an FNA has yielded clear fluid, and has eliminated both the
cyst and any associated symptoms, it is safe to conclude that the
cyst was benign and the patient requires no further evaluation at
this time. In this case, it is reasonable to instruct your patient
to return as needed, should a cyst recur. Patients with one breast
cyst, many of whom have fibrocystic breasts, are at increased risk
of a cyst recurrence.
An FNA that reveals a non-draining mass, a partially-draining mass,
or non-clear fluid indicates the need for further evaluation of
the lesion (Ciatto, Goodson, Maygarden, Takeda). Order a mammogram and/or breast ultrasound,
and refer the patient for biopsy.
| 
Send
to a friend
Printer
friendly page
Get
PDF
