Needle Aspiration Cytology or FNA
Over the past few years, Fine Although Needle
Aspiration Cytology or FNA has been used extensively as a
mean to establish a histological diagnosis for suspicious
breast masses. Although, most surgeons use this technique
for palpable breast masses, it is also used for
suspicious mammographic lesions.
The concept of this procedure is to capture a few
representative cells of the identified breast lesion in
the aspirate to obtain an accurate histological
Problems inherent to this
- Insufficient Specimen: One of the major draw back
of this technique is to obtain an insufficient
specimen. The rate of insufficient specimen
varies from 2 to 36%.
- Reported Sensitivity ranges from 68 to 100% and
the specificity from 2 to 36%.
- General Inability to differentiate In-situ from
A specially designed Gun-Syringe can be used. Most
surgeons will use one or several 10 cc luer-lock syringes
with a long 20 G needle.
- Step 1:
Identifying the Lesion and finding the best entry
site or access.
- Step 2:
The FNA: No local anesthetic
agent is used. The breast is held under tension.
The surgeon will insert the needle and will
repetitively pass through the lesion.
Simultaneously, negative pressure is applied as
soon as the needle enter the skin. The pressure
is released immediately prior to removing the
needle from the breast. The same maneuver is
repeated.This maneuver is usually repeated twice
(using two different needles and syringes).
- Step 3:
Collecting the specimen and Preparing the Slides:
- 1. Label Slides:
Mark all the submitted slides or fluids
with patients name. If several sites are
aspirated, indicate site on slide.
- 2. Place small amount of
material on the slides:
Prepare smears using a small amount of
material and as little blood as possible.
- 3. Prepare smears:
If possible prepare at least 6 slides. We
recommend fixing half and leaving the
other half air-dried. Slides need to be
fixed immediately after preparation by
either of two methods: 1. Immerse slides
in 95 % alcohol; paper clip on the
frosted end will keep the slides apart in
the jar; or (2) spray the slides with
cytology fixative (e.g. Pro-Fixx). Place
all slides in blue slide holders for
- 4. If the specimen is unsuitable
for the preparation of smears (e.g.,cyst
contents), express the syringe contents
into the smaller jar containing Saccomano
- Step 4:
Applying Pressure: Pressure is
applied to minimize the post-operative hematoma.
- Step 5:
Staining for FNA.
A. Airdryed smears are
stained with Diff-Quick Stain as follows:
- 1. Fixative 20 seconds
- 2. Staining solution I: 20
- 3. Staining solution II: 20
- 4. Distilled water: 10 seconds
- 5. 95 % Ethyl alcohol: 10
- 6. Absolute alcohol: 15
- 7. Xylene: 15-20 seconds
B. Alcohol Fixed Smears
stained with Papanicolaou Stain
C. Needle rinse is prepared
for CELL BLOCK and stained with H&E Stain.
- Jakson VP et al.: Stereotactic fine-needle
aspiration biopsy for non palpable breast
lesions. AJR Am J Roentgenol 1990:154:1196-1197
- Massod S: Occult breast lesions and aspiration
biopsy: A new challenge. Daign Cytopathol