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A biopsy is the removal of tissue or cells for medical analysis. For proper diagnosis, especially for mesothelioma or other cancers, a doctor may perform a biopsy in several ways. The safest and least invasive biopsy method uses a thin needle to extract tissue or fluid from a potentially cancerous mass. Most patients will have a fine needle aspiration performed before undergoing more invasive procedures to confirm diagnosis.
What is a Fine Needle Aspiration?
Fine needle aspiration is a common biopsy procedure. During this type of biopsy a fine needle is used to draw fluid or tissue into a vacuum. Fine needle aspiration is a quick and easy outpatient procedure.
Fine needle aspiration is also considered low-risk. For this reason, it is often a first step in mesothelioma diagnosis. It can be used to take fluid samples from the pleura, abdominal cavity, or pericardium for diagnostic purposes. With few exceptions, fine needle aspiration can also be used to remove tissue from a lump in suspected cancerous areas.
Blind versus Guided Needle Biopsy
A blind fine needle aspiration is a biopsy performed without imaging to guide it. This yields a very low rate of confirming cancer, or better described it can lead to false negatives. This means a negative result does not mean there is no cancer, rather, the needle did not properly take a sample from the correct place. This technique is often used after a patient has had a chest x-ray to confirm a pleural effusion (fluid build-up in the pleura). The needle doesn’t need to be guided to extract fluid for examination. This procedure is not perfectly accurate in diagnosing mesothelioma.
A guided fine needle aspiration is a biopsy used in conjunction with an imaging technique. It provides more accurate and safer results. Ultrasound or CT scans are the imaging methods used most often. The imaging helps guide accurate needle insertion. This technique is much more effective for accurate mesothelioma diagnosis.
Fine Needle Aspiration of the Lymph Nodes to Diagnose Mesothelioma
Diagnosing pleural mesothelioma is not a simple process. Mesothelioma is often misdiagnosed as something less serious. This misdiagnosis can shorten life expectancy. In some cases, a fine needle biopsy of the pleura ruled out mesothelioma, but a subsequent biopsy of the lymph nodes confirmed it. Although pleural mesothelioma is cancer of the pleura, testing tissue in the lymph nodes will give a more accurate diagnosis for some patients. This may be because the cancer has spread from the pleura to the lymph nodes, where cancer cells are easier to detect.
What to Expect
It’s normal to feel nervous about any medical procedure. However a thin needle biopsy is relatively simple, quick, and mildly uncomfortable. Still, knowing what to expect can help ease your mind and make you feel more comfortable.
First, the skin area where the needle will be inserted, will be cleaned and disinfected. This prevents infection due to skin penetration by the needle. The doctor or assistant will then cover the surrounding area with sterile materials.
Depending on the location of the biopsy and the size of the needle, you may be injected with local anesthetic to numb the area. The numbing itself will cause a slight sting or pinching feeling.
During a guided biopsy, an ultrasound device may be used to image the area under the skin. Imaging is painless and allows the doctor to see where the tissue to be sampled is located. This will allow the procedure to be performed more quickly and accurately.
Finally the doctor will insert a thin needle attached to a syringe into the skin. The syringe has a vacuum that pulls up fluid, tissue, or both from the suspected tumor. Overall the process is relatively quick.
After the Biopsy
A fine needle biopsy is quick and causes few side effects. Complications of this procedure are generally unlikely. However, you may experience pain or swelling at the needle site. An over-the-counter medication will reduce soreness and inflammation. In rare cases, a patient may experience a hematoma (bleeding under the skin) or infection.
Depending on the lab, results from a fine needle aspiration biopsy may take up to seven days. Typically there will be one of four results: definitely not cancer, definitely malignant cancer, non-definitive, or inadequate sample for results.
When results are definitely cancer or are unclear, the next step is usually a more invasive biopsy. If there were not enough sample to get conclusive results, another needle biopsy will usually be performed.
Fine needle aspiration is a useful technique for diagnosing mesothelioma. However, this method is not perfect. Cancer cannot be definitively diagnosed or ruled out using this technique. This is why diagnostic strategies typically include several procedures for the greatest accuracy.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.