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Small Needle Biopsy

Small Needle Aspiration

Keywords and Terms: small needle biopsy, lymphedema, arm lymphedema, leg lymphedema, small needle aspiration, cancer, inflammation,, infection, fine needle aspiration, core needle biopsy, vacuum-assisted biopsy, large core biopsy, Stereotactic core needle biopsy, cytolgy, transthoracic biopsy, mediastinal tumor, sofe tissue tumor, breast biopsy, gynecologic needle biopsy, lung needle biopsy, pleural needle biopsy, hepatocellulat carcinoma nodule, HCC, Pancreas, Pancreatice Adenocarcinoma, bone marrow, intrapancreatic accessory spleen, endoscopic ultrasound, epidermoid cyst, lobular carcinoma, metastatic oligodendroglioma, glial tumor, breast mass, breast fine needle aspiration, fine needle aspiration of palpable lesions, diagnostic accuracy

Fine Needle Aspiration

A procedure used more and more in the detection of cancers and in the biopsy of suspect areas is the needle aspiration. More commonly, patients refer to it as simply a “small needle biopsy.”

In the procedure, a small amount of tissue is removed and it can be used to make a diagnosis of a number of medical problems including cancer, infections or inflammation or infection. Any lump, bump, growth or suspect area can have a small needle biopsy done.

In most hospitals, the most commonly biopsied organ is the breast. FNA, particularly in conjunction with clinical examination and mammography, is very useful in evaluating breast masses. Breast masses are common, but only a small percentage of these, in fact, have cancer. One of the other commonly biopsied organs is the thyroid. Thyroid nodules are also common and are only rarely the result of the cancer. FNA is also very useful in deciding what the thyroid nodules are due to. Lymph node FNA is the third most common area. This is most commonly used to detect metastatic cancer. The two most common nonpalpable organs that are biopsied are the liver and the lung. In these organs, the most common question is whether a nodule identified by x-ray is cancerous or not.

Because the procedure does not remove any lymph nodes nor does it destroy lymphatic vessels, I am a major supporter of this procedure to prevent lymphedema. Hopefully, we can put an end to arm or leg swelling after cancer.

Implication for Pre-existing Lymphedema

I have advanced stage hereditary bilateral leg lymphedema. This has made getting a safe biopsy problematic for cancer diagnoses

The good news is that this procedure is safe and effective for those already with lymphedema. In 2000, I had an ultrasound guided small needle biopsy of a right inguinal lymph node.

I developed no secondary complications and it had no negative affect on my leg lymphedema.

The procedure was accurate enough to diagnose lymphoplasmacytic lymphoma.

Also, thus far, I have not heard of any secondary lymphedema being caused by a needle biopsy.

Advantages of this procedure

It leaves lymph nodes intact taking only a minimal core sample. It is done on an outpatient basis with only a local anesthesia. Because it is minimally invasive, patients run a far less chance of experiencing complications or infections.

Disadvantages of this procedure

Excisional biopsies may be more accurate, depending on the condition being diagnosed.

Preparation for a needle biopsy

You may be told to restrict food and fluids for a certain period of time before the test depending on the area biopsied.

If you are taking any medications (prescription or over-the-counter), especially aspirin or blood thinners, it is important to inform your doctor before you have this exam.

Blood tests will be performed prior to the procedure to determine clotting factors, etc. These tests are no different then ones that might be performed for a larger excisional biopsy.

You will be asked to stop taking any blood anticoagulant medications.

During the biopsy

After you change into a hospital gown, vital signs (pulse, blood pressure) will be taken. Depending on the nature of the biopsy, an intravenous line (IV) may be placed in a vein in your arm. Medications to help decrease anxiety are often given by mouth or directly into your intravenous line before the biopsy is obtained.

You will be positioned so that the pathologist or radiologist has easy access to the area to be biopsied. The skin will be swabbed with an antiseptic solution, and you will receive a local anesthetic so you feel little pain.

An X-ray of the area will be done as needed before and, sometimes, during the biopsy. After the mass ( tumor) is located, the doctor inserts a needle into it and withdraws a specimen of cells that are then sent to the lab. It is not uncommon to have multiple needles inserted. Several areas may need to be biopsied to ensure that samples from the suspicious area are obtained.

A lung biopsy, done in this manner, takes 30 minutes to 60 minutes. Breast and prostate needle biopsies take 30 minutes or less. A liver biopsy can take about 10 minutes to 15 minutes.

Possible Complications

Bleeding is the most common complication of this procedure. A slight bruise also may appear at the site of the biopsy. If a lung or kidney biopsy has been performed, it is very common to see a small amount of blood in sputum or urine afterward. Only a small amount of bleeding should occur.

Other complications depend upon the area biopsied. Lung biopsies sometimes cause a collapsed lung.

This complication also can accompany biopsies in the upper abdomen near the base of the lung. About one quarter to one half of patients having lung biopsies may develop a small lung collapse. If there is a large lung collapse, it is treated successfully with a chest tube and suction in the hospital.

For biopsies of the liver, bile leakages and/or liver hematomas may occur, but these are quite rare. Pancreatitis (inflammation of the pancreas) may occur after biopsies in the area around the pancreas. Pain and infection may occur after a biopsy.

Deaths have been reported from internal (abdominal or chest) needle aspiration biopsies, but their occurrence is extremely rare. Your doctor is the best person to explain the risks and benefits associated with the type of biopsy that you undergo.(1)

(1) Health A to Z

Preparing for a Needle Aspiration Biopsy

This information will inform you and your family about a diagnostic procedure called a needle aspiration biopsy. It will explain the nature of this procedure and what to expect when you are scheduled for a needle aspiration biopsy.

What is a needle aspiration biopsy?

A needle aspiration biopsy is a procedure that helps your doctor diagnose and treat your illness. Thin needles will be 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 biopsy can be avoided by performing a needle aspiration biopsy instead.

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.

Why would I need a needle aspiration biopsy?

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 being conducted at the National Institutes of Health.

Your doctor will discuss why you need a biopsy as well as the risks and benefits of this procedure. All biopsies involve some risks, but they are requested because their potential benefits outweigh their risks. A needle aspiration biopsy is safer and less traumatic to your body than an open surgical biopsy.

Who will perform the biopsy?

The biopsy will be performed by a diagnostic radiologist, a doctor with special training in performing and inter-preting x-ray procedures and in performing biopsies using x-ray guidance. Another staff member, called a cytopathologist, will also be present. This person has expertise in identifying normal and abnormal cells. Your Clinical Center doctor usually will not be present when the biopsy takes place.

How will the biopsy be performed?

During this procedure, a very thin needle will be used to remove cells or other material from a tumor or mass in your body. These cells will then be given to the cytopathologist.

It will take several days for the cytopathologist to make a diagnosis, and one will not be given at the end of the biopsy. There may be times when a diagnosis cannot be made; not all cells removed during a needle aspiration biopsy can be identified with certainty.

What happens before a needle aspiration biopsy?

Several preparations are necessary before this procedure.

oDo not take any aspirin or aspirin substitutes (ibuprofen, Motrin, Advil, Naprosyn) for 1 week before the procedure unless your doctor instructs you otherwise.

oYou may take Tylenol.

oYou will be asked not to eat for a specified time before the procedure.

oIf an abdominal CT scan is to be done, you may be given a drink containing x-ray contrast material (dye). If intravenous contrast material is necessary, and you have an allergy to it, you will be given medication to counteract the effects of this material before the procedure.

oSome routine blood work (blood counts, clotting profile) must be completed 2 weeks before the biopsy.

oBleeding disorders will be managed before the procedure.

oBlood thinners (anticoagulants) will be stopped for a period of time before the test. oAntibiotics may be given.

Your Clinical Center doctor will inform you about any or all of these requirements.

After arriving at the Diagnostic Radiology check-in desk, you will be guided to the area where the biopsy will be performed. Please arrice 30 to40 minutes before your scheduled time, especially if you know that oral contrast material will be needed. Because many people must work together during this procedure, your promptness is important. We will also do our best to perform the biopsy at the scheduled time.

What happens during the biopsy?

Shortly after you check in to the Diagnostic Radiology Department, you will meet the radiologist who will perform the biopsy. The radiologist will tell you about the procedure and will answer any questions you may have. You will then be asked to sign an informed consent form.


After you change into a hospital gown, vital signs (pulse, blood pressure) will be taken. Then, depending on the nature of the biopsy, an intravenous line (I.V.) may be placed in a vein in your arm. 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.

You will be awake and aware during this biopsy. It is important that you are able to respond when asked to take breaths or to assume certain positions.


You will be positioned (usually lying on your front or on your back) so that the radiologist has easy access to the area for biopsy. The skin in this area will be swabbed with a cool antiseptic solution and draped with sterile surgical towels. After the antiseptic has been applied, do not touch the area.

The skin, underlying fat, and muscle will then be numbed with a local anesthetic.

Needle placement

The radiologist will choose an x-ray technique to locate the mass for biopsy. Needles will be passed into the mass. These needles may look alarming because they are quite long. However, they are very thin, and usually the whole length of a needle is not inserted.

You will notice that the needles may be inserted and withdrawn several times. There are many reasons for this:

oOne needle may be used as a guide, with the other needles placed along it to achieve a more precise position.

oSometimes, several passes may be needed to obtain enough cells for the intricate tests which the cytopathologists perform.

oWhen the mass is small, several passes may be necessary to position properly the needle tip. You should expect about two to four needle passes during the biopsy.

After the needles are placed into the mass, cells will be withdrawn and given to the cytopathologist. When the cytopathologist has enough cells to work with, the biopsy will usually end. Your vital signs will be taken again, and you may return either to your patient care unit for observation or to the Radiology holding area to be observed for several hours. Outpatients will generally be observed for about 3 to 5 hours.

If you go home after the test, you must be driven home. Do not drive until the day after the procedure. Depending on the site of your biopsy, you should not plan on flying home the same day. If you must fly home immediately, please discuss this with your doctor.


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.


Biopsies cause some pain. While the perception of pain is subjective and varies from person to person, most patients feel that biopsies hurt a bit, but that they are tolerable.

To help ease any pain during the procedure, a local anesthetic will be given. Intravenous painkillers can be used, but most patients do not require them.

Please tell the radiologist if you feel pain during the procedure, and adjustments in the medications can be made. Often, just remaining calm and taking slow, deep breaths will make the discomfort more bearable.

After the procedure, mild painkillers such as Tylenol will control pain quite well. Aspirin or aspirin substitutes (Motrin, Naprosyn) 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.

Other complications

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

Lung biopsies are frequently complicated by “pneumo-thorax” (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. Specific complications which might be expected from your particular biopsy will be explained to you before you sign the informed consent form.

The health care staff who will be working with you has extensive experience with this type of biopsy. The staff of the Diagnostic Radiology Department hopes that this information helps you and your family understand what will happen during your needle aspiration biopsy.

If you still have unanswered questions, do not hesitate to call on your doctor, nurse, or the staff of the Diagnostic Radiology Department.

Patient Information Publications

Needle Aspiration

This type of biopsy uses a needle to aspirate (draw out) fluid or tissue from a breast lump. Needle aspiration leaves no scarring, is less invasive and quicker than open excisional biopsy, and usually does not require stitches or a recovery period. The patient can resume regular activities immediately.


Needle aspiration procedures include the following:

·Fine needle aspiration

·Core needle biopsy

·Vacuum-assisted biopsy

·Large core biopsy

Each procedure differs in how it is performed, the equipment used, the type of lesion it works best on, and the amount of tissue it removes. Unlike surgical biopsy, needle aspiration cannot remove the entire lesion and misdiagnosis can occur.

Fine Needle Aspiration

This procedure is performed under local anesthesia. The surgeon uses a fine hollow needle that is attached to a syringe to extract fluid from a cyst or cells from a solid lesion. The needle used in this procedure is very small (smaller than those used to draw blood). Several insertions are usually required to obtain an adequate sample. The procedure takes a few minutes and is often done in a doctor's office.

If the lump cannot be felt, ultrasound may be utilized to help the physician guide the needle into the breast and to the lesion. Stereotactic mammography may also be used. This mammography utilizes a computer to pinpoint the mass or cyst. Mammograms are taken from two angles and the computer maps the precise location of the lesion.

There is no incision and a very small bandage is put over the site where the needle entered. Fine needle aspiration is the easiest and fastest method of obtaining a breast biopsy, and is very effective for women who have fluid filled cysts. However, the pathological evaluation can be incomplete because the tissue sample is very small. When used alone, about 10% of breast cancers may be missed. The effectiveness of this procedure depends on the skill of the surgeon or radiologist who performs it.

Core needle biopsy

This procedure is similar to fine needle aspiration, but the needle is larger, enabling a larger sample to be obtained. It is performed under local anesthesia and ultrasound or stereotactic mammography is used if the lump cannot be felt.

Three to six needle insertions are needed to obtain an adequate sample of tissue. A clicking sound may be heard as the samples are being taken and the patient may feel some pressure, but should not feel pain. The procedure takes a few minutes and no stitches are required.

Core needle biopsy may provide a more accurate analysis and diagnosis than fine needle aspiration because tissue is removed, rather than just cells. This procedure is not accurate in patients with very small or hard lumps.

Vacuum-assisted biopsy

This method utilizes a vacuum-like device to remove breast tissue. Local anesthesia is used and no incision is made. Stereotactic mammography is used to guide a breast probe to the lesion. Computers pinpoint the mass and suction draws out the breast tissue. The needle is inserted once to obtain multiple samples. In some cases, the entire lesion may be removed.

Vacuum-assisted biopsy is safe, reliable, and valuable for patients who are not candidates for other minimally invasive biopsy techniques and those who wish to avoid surgical biopsy. The procedure should be performed by a highly skilled radiologist or surgeon who is experienced and familiar with this method.

Large core biopsy

This procedure, also called advanced breast biopsy instrumentation (ABBI), is an alternative for patients who prefer a less invasive procedure than surgery. Large core biopsy is able to remove a sizeable specimen or an entire lesion using a surgical device and stereotactic mammography. It combines wire needle localization and the ability to remove a tissue specimen and allows the sample to be removed in one piece.

Oncology Channel

Stereotactic Core Needle Biopsy

Mammograms can detect cancers that you can’t feel and that are not seen by ultrasound. Today, the Stanford Cancer Center is able to perform less-invasive, convenient outpatient core needle biopsies on lesions that are visible by mammogram, using a technique called stereotactic core needle biopsy.

Breast cancers are most often seen on mammography. At times they can only be identified by using ultrasound. And less commonly they are only detected by palpation (examination) of the breast. However, nearly all breast cancer can be seen by mamography and ultrasound.

How Stereotactic Core Needle Biopsy Works

Stereotactic core needle biopsies are possible because of new mammogram technology that lets doctors visualize the breast in real-time while taking the biopsy in the mammogram office. The stereotactic mammogram set up places a woman face down on a table with holes that her breasts hang through. The breast is in a mammographic machine and tumors are visualized by the mammographer who places a needle in the tumor to obtain a small tissue sample.

Stanford Hospital

Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort.

Mar 2012

Sung JY, Na DG, Kim KS, Yoo H, Lee H, Kim JH, Baek JH.


Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul, South Korea.


OBJECTIVES: To retrospectively compare the accuracy of fine-needle aspiration (FNA) and core-needle biopsy (CNB) for the diagnosis of thyroid malignancy

METHODS: We evaluated the results of FNA and CNB in 555 consecutive thyroid nodules with final diagnoses (malignancy 318, benign 237). All patients underwent FNA and CNB simultaneously for each nodule. We assessed the sensitivity, specificity and accuracy of FNA, CNB and FNA/CNB for the diagnosis of thyroid malignancy.

RESULTS: The sensitivity of FNA, CNB and FNA/CNB for thyroid malignancy was 68.6%, 86.8% and 90.6%, specificity 100%, 99.2% and 99.2%, and accuracy 82.0%, 92.1% and 94.2%, respectively. The sensitivity and accuracy of CNB or FNA/CNB for thyroid malignancy were significantly higher than those of FNA (P < 0.001). Compared with CNB alone, FNA/CNB was more accurate for thyroid malignancy only in small nodules less than 1 cm (P < 0.001).

CONCLUSIONS: Our clinical cohort data demonstrated that CNB was more accurate for the diagnosis of thyroid malignancy than FNA, and FNA/CNB was more accurate than CNB alone in small thyroid nodules. CNB will play a complementary role in optimal surgical decision-making and the management of thyroid nodules.

KEY POINTS: • CNB was more accurate for the diagnosis of malignancy than FNA. • Combined FNA/CNB was more accurate than CNB alone in small thyroid nodules. • CNB should play at least a complementary role in managing thyroid nodules.


Role of core needle biopsy in the treatment of radial scar.

Mar 2012

Tóth D, Sebő E, Sarkadi L, Kovács I, Kiss C, Damjanovich L.


Department of General Surgery, Kenézy Teaching Hospital, 2-26 Bartók Street, Debrecen 4043, Hungary.


Keywords Core needle biopsy; Fine-needle biopsy; Radial scar; Sensitivity and specificity

Invasive tumor or ductal carcinoma in situ occur in radial sclerosing lesions in one third of the cases therefore, surgical excision is mandatory. Forty-five patients with radial scar morphology were examined. Ultrasound guided fine-needle aspiration biopsy (FNAB) and core biopsy (CB) were performed in all cases. The postoperative pathological findings were compared to the results of preoperative biopsies. Sensitivity of preoperative percutaneous biopsies (FNAB and CB) was 17.6% and 70.6%, false-negative rate was 82.4% with FNAB and 29.4% with CB. The negative predictive value was 48.1% and 84.8% respectively. Had we done preoperative cytology only, we would have had to perform a two-step procedure (sentinel lymph node biopsy) in 7 patients (15.6%), while with preoperative core biopsy it has decreased to 2 patients (4.4%). Preoperative CB in small radial stellate lesions is recommended to achieve accurate diagnosis in order to avoid a two-step surgical procedures.

Science Direct

Fine-needle aspiration cytology of metastatic oligodendroglioma: case report and literature review.


Can B, Akpolat I, Meydan D, Uner A, Kandemir B, Söylemezoğlu F.


Department of Pathology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.


Background: Systemic metastasis of a glial tumor is a rare event. However, metastatic cases are anticipated to increase due to prolongation of survival as a result of the development of new treatment modalities. The possibility of metastasis should be considered in patients with a history of a glial tumor rather than a second primary tumor. Fine-needle aspiration cytology is one of the diagnostic procedures primarily applied for confirmation of metastasis in cases with a known primary focus. Therefore, comprehensive knowledge of diagnostic cytomorphologic findings is required in these cases.

Case Report: We report a young woman with oligodendroglioma metastasizing to the cervical lymphatic chain 5 years after initial diagnosis. Fine-needle aspiration cytology revealed a highly cellular smear with dispersed single cells and loosely cohesive cell clusters showing rosette-like features on a clean background. The relatively monotonous tumor cells were small sized and had round nuclei with moderate anisonucleosis and scant cytoplasm without extensions. Diagnostic confirmation was made by excisional biopsy and demonstration of 1p19q codeletion on tissue section by fluorescence in situ hybridization.

Conclusion: A brief review of the literature with an emphasis on the cytologic features of metastatic oligodendroglioma and differential diagnosis with respect to other metastatic small round cell tumors is provided.


The value of fine needle aspiration biopsy in the diagnosis and prognostic assessment of palpable breast lesions.

Jan 2012 (Diagnostic Cytopatholoy)

Rosa M, Mohammadi A, Masood S.


Department of Pathology and Laboratory Medicine, University of Florida, College of Medicine, Jacksonville, Florida 32209, USA.


Keywords: breast mass; breast fine needle aspiration; fine needle aspiration of palpable lesions; diagnostic accuracy; prognostic/predictive factors

In recent years there appears to be a growing movement toward the use of core needle biopsy (CNB) over fine needle aspiration biopsy (FNAB) for the detection of breast carcinoma. This tendency is caused in part by the idea that CNB can provide a more specific or definitive diagnosis as well as the belief that the assessment of prognostic/predictive factor is not possible or reliable on cytologic specimens. At our institution, FNAB of breast has been practiced for over 25 years with excellent cytologic-histological correlation. This practice has been beneficial not only for patients, but also for training physicians since nowadays a very small number of centers in the United States still routinely perform fine needle aspiration as a diagnostic tool in breast cases. To assess the diagnostic accuracy of FNAB in palpable breast lesions, we reviewed our experience during an 8-year-period and compared fine needle aspiration results with follow-up surgical specimens. From the cytology point of view, the lesions were divided as negative/benign, atypical/suspicious, positive, and insufficient. Only cases performed by pathologists were included. A total of 1,583 cases were retrieved from our archives. A definitive malignant diagnosis was reached in 357 cases. One-hundred and thirty-nine cases were classified as atypical/ suspicious, 135 cases had insufficient cells for establishing a diagnosis, and 952 were categorized as negative. A total of 408 follow-up surgical specimens were available for comparison with cytologic results. There were 19 false-negative, and no false-positive results were found. The majority of false-negative results were secondary to sampling errors. In 93% of the malignant cases, there was enough material obtained in cytological specimens to perform prognostic/predictive factors studies. Our data proves once again that FNAB is a reliable method for the initial evaluation and diagnosis of palpable masses of the breast. In addition, it also has the ability of providing necessary progno

Wiley Online

Nodular lymphocyte-predominant Hodgkin lymphoma: Cytopathologic correlates on fine-needle aspiration.

Feb 2012

Subhawong AP, Ali SZ, Tatsas AD.


Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.


Keywords: fine-needle aspiration;nodular lymphocyte-predominant Hodgkin lymphoma;lymphocyte-predominant cell;cytopathology

BACKGROUND: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), a rare subtype of Hodgkin lymphoma, is an indolent tumor with frequent instances of disease recurrence but a favorable prognosis. To the best of the authors' knowledge, there are only limited descriptions of NLPHL in the cytology literature because it was only formally recognized as a distinct entity in 1994.

METHODS: In the current study, all cases of NLPHL diagnosed on excisional biopsy (n = 6 cases) at the study institution between 2000 and 2011 that had undergone previous fine-needle aspiration (FNA) were reviewed, with a focus on cytomorphologic features.

RESULTS: Four of 6 cases were termed benign on FNA; however, there was retrospective recognition of characteristic LP cells in all cases. Unlike classical Hodgkin lymphoma, the tumor cells of NLPHL were often found to be mononucleate and presented in a background of small lymphocytes. Other features identified included epithelioid histiocytes and numerous bare atypical nuclei.

CONCLUSIONS: Cases of NLPHL are commonly misdiagnosed as benign reactive lymphoid tissue and therefore a careful search using high magnification for LP cells is recommended in the evaluation of lymph node FNAs. Cancer (Cancer Cytopathol) 2012


Fine needle aspiration of intrapancreatic accessory spleen: Cytomorphologic features and differential diagnosis.

Feb 2012

Tatsas AD, Owens CL, Siddiqui MT, Hruban RH, Ali SZ.


Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Hospital, Baltimore, Maryland.


Keywords: intrapancreatic accessory spleen;fine needle aspiration;endoscopic ultrasound;pancreas;epidermoid cyst

BACKGROUND: Intrapancreatic accessory spleen (IPAS) is a rare benign lesion of the pancreas that frequently clinically and radiographically mimics a solid neoplasm. Very rarely, epidermoid cysts may form in IPAS and be mistaken for a cystic neoplasm of the pancreas on radiographic imaging. IPAS and epidermoid cyst involving intrapancreatic cyst (ECIPAS) are benign, and, if recognized, do not require surgical intervention. There are few reports of the cytopathologic features of IPAS diagnosed by fine needle aspiration (FNA).

METHODS: Here we report a series of 6 cases of endoscopic ultrasound (EUS)-guided FNA of IPAS, 3 of which had histological confirmation, including 1 case of histologically confirmed ECIPAS.

RESULTS: Cytomorphologic features of IPAS include a polymorphous population of hematopoietic cells, including lymphocytes, eosinophils, histiocytes, plasma cells, and red blood cells, admixed with numerous small blood vessels representing splenic sinusoids. CD8 immunostaining of cell block or core biopsy material highlights splenic endothelial cells and confirms the diagnosis. FNA of ECIPAS reveals predominantly macrophages and proteinaceous debris.

CONCLUSIONS: Diagnostic pitfalls include pancreatic neuroendocrine tumor. If IPAS is recognized as a diagnostic consideration on EUS-FNA, unnecessary surgical resection may be avoided. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.


Management of patients diagnosed with lobular carcinoma in situ at needle core biopsy at a community-based outpatient facility.

Feb 2012

Destounis SV, Murphy PF, Seifert PJ, Somerville PA, Arieno AL, Morgan RC, Young WL.


Elizabeth Wende Breast Care, LLC, 170 Saw-grass Dr, Rochester, NY 14620.


OBJECTIVE: The objective of our study was to show the importance of surgical excision after the diagnosis of lobular carcinoma in situ (LCIS) based on needle core biopsy.

MATERIALS AND METHODS: Retrospective evaluation of all cases of LCIS diagnosed at needle core biopsy from 2000 to 2011 was performed; 60 patients with 64 diagnoses of LCIS comprise the cohort. Data recorded included patient demographics, patient presentation, breast density, personal and family histories of breast cancer, lesion characteristics, biopsy method, and correlation of core results with surgical pathology or follow-up imaging. The pathology facility was recorded for all biopsies because the specimens from open surgical biopsy were frequently reviewed by a different laboratory.

RESULTS: A total of 60 patients with 64 diagnoses of LCIS comprised the study cohort. The patients ranged in age from 36 to 93 years (average, 55 years). The lesions consisted of 39 calcifications, two masses with calcium, 10 masses, two asymmetries, two architectural distortions, two architectural distortions with calcifications, and seven MRI enhancements. Mammography detected lesions in 84% of the cases (n = 54) and 16% (n = 10) were not visualized. Sonography detected lesions in 30% of the cases (n = 19) and 70% (n = 45) were sonographically occult. Needle core biopsy was performed in all cases: 49 stereotactic biopsies (77%), 12 ultrasound-guided biopsies, and three MRI-guided biopsies. All but one case proceeded to surgery. Open surgical biopsy revealed 21 cancers (33%); of the remaining cases, 53% of the cases (n = 33) were atypical or high risk and 14% (n = 9) were benign.

CONCLUSION: The diagnosis of LCIS at needle core biopsy, in this small study, revealed that 84% of lesions either were malignant or were atypical or high risk at surgery, of which 33% were found to be carcinoma. Our findings suggest that LCIS should be excised when noted at core biopsy.


Two smalls in one: Coincident small cell carcinoma and small lymphocytic lymphoma in a lymph node diagnosed by fine-needle aspiration biopsy.


Afify A, Das S, Mingyi C.


Address: Department of Medical Pathology and Laboratory Medicine, UC Davis Health System, 4400 V Street, PATH Building, Sacramento CA 95817.


BACKGROUND: B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma (CLL / SLL) is one of the most common lymphoproliferative disorders in western countries. Patients with SLL / CLL are at increased risk of site-specific secondary cancers. We present a unique case of a 71-year-old male, with a history of SLL / CLL, who presented with pulmonary symptoms and a mediastinal mass. Fine needle aspiration (FNA) of the mediastinal lymph node revealed synchronous SLL / CLL and small cell carcinoma (SCC).

MATERIALS AND METHODS: The patient underwent a computed tomography (CT) scan of the chest and endobronchial ultrasound-guided transbronchial fine needle aspiration of the mediastinal lymph node (4R). The sample was submitted for cytopathology, immunohistochemical stains, and flow cytometry evaluation.

RESULTS: Fine needle aspiration of the mediastinal lymph node revealed neoplastic cells, in clusters and singly, with cytological features suggestive of small cell carcinoma. The immunohistochemistry results confirmed this diagnosis. Small-to-medium, mature-appearing lymphocytes were also present in the background. Flow cytometry analysis revealed that these lymphocytes possessed an immunophenotype consistent with CLL / SLL.

CONCLUSIONS: This case illustrates the importance of a pathologist's awareness of the possibility of concurrent lymphoma and metastatic carcinoma in a lymph node. When evaluating lymph nodes, pathologists must strive to identify both foreign cells and subtle lymphoid changes. As demonstrated by our case, ancillary techniques (such as immunohistochemistry and flow cytometry) can be critical to making a complete and accurate diagnosis. The diagnosis of small cell carcinoma in the enlarged lymph node, primarily harboring CLL / SLL, is of critical importance for decision-making and treatment purposes, in addition to having a significant adverse impact on the overall survival.


Accuracy of fine needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic histologic correlation

Cancer. 2008 Feb 19 Alkuwari E, Auger M.

Department of Pathology, McGill University Health Center, McGill University, Montreal, Quebec, Canada.

BACKGROUND: Fine-needle aspiration (FNA) cytology of axillary lymph nodes is a simple, minimally invasive technique that can be used to improve preoperative determination of the status of the axillary lymph nodes in patients with breast cancer, thereby serving as a tool with which to triage patients for sentinel versus full lymph node dissection procedures. The aim of the current study was to determine the sensitivity and specificity of FNA cytology to detect metastatic breast carcinoma in axillary lymph nodes.

METHODS: A total of 115 FNAs of axillary lymph nodes of breast cancer patients with histologic follow-up (subsequent sentinel or full lymph node dissection) were included in the current study. The specificity and sensitivity, as well as the positive and negative predictive values, were calculated.

RESULTS: The positive and negative predictive values of FNA cytology of axillary lymph nodes for metastatic breast carcinoma were 1.00 and 0.60, respectively. The overall sensitivity of axillary lymph node FNA in all the cases studied was 65% and the specificity was 100%. The sensitivity of FNA was lower in the sentinel lymph node group than in the full lymph node dissection group (16% vs 88%, respectively), which was believed to be attributable to the small size of the metastatic foci in the sentinel lymph node group (median, 0.25 cm). All false-negative FNAs, with the exception of 1 case, were believed to be the result of sampling error. There was no 'true' false-positive FNA case in the current study.

CONCLUSIONS: FNA of axillary lymph nodes is a sensitive and very specific method with which to detect metastasis in breast cancer patients. Because of its excellent positive predictive value, full axillary lymph node dissection can be planned safely instead of a sentinel lymph node dissection when a preoperative positive FNA result is rendered. Cancer (Cancer Cytopathol) 2008. © American Cancer Society.

PMID: 18286535 [PubMed - as supplied by publisher]

Transthoracic biopsy with core cutting needle (Trucut) for the diagnosis of mediastinal tumors.

Rev Port Pneumol. 2009

Zamboni M, Lannes DC, Cordeiro Pde B, Toscano E, Torquato EB, Cordeiro SS, Cavalcanti A. Pulmonologist, Thoracic Oncology Group, HC I - INCA/MS, Rio de Janeiro, RJ, Brazil.

AIM: To determine the contribution of percutaneous biopsy with core cutting needle (Trucut) in the diagnosis of mediastinal tumours.

METHOD: Retrospective review of 56 patients with mediastinal lesions who underwent percutaneous core cutting needle biopsy, oriented but not guided by computer assisted tomography of the thorax, 1999 - 2008.

RESULTS: Percutaneous biopsy with core cutting needle provided adequate material in 49/56, with a total positive sample rate of 88%. In 7/56 (12%) cases the material was insufficient to define the diagnosis. Percutaneous core cutting needle biopsy established a specific histological diagnosis in 88% of the patients: 23/56 (41%) lymphomas; 12/56 (21%) thymomas; 5/56 (3%) thymic carcinomas; 3/56 (2%) small cell carcinoma and 1/56 (0.6%) metastatic adenocarcinoma, metastatic squamous cell carcinoma, neuroendocrine primitive carcinoma, plasmocytoma, teratoma and goiter. All patients underwent thoracic X-ray after the procedure. No complications were found in these patients.

CONCLUSION: Percutaneous core cutting needle biopsy (Trucut) oriented but not guided by computer assisted tomography of the thorax is an easy and safe procedure which can provide a precise diagnosis in the majority of mediastinal tumours and can prevent the need for exploratory thoracic surgery in cases which are medically treatable or non-resectable.

PMID: 19547893 PubMed - in process

Does image guidance improve accuracy of core needle biopsy in diagnosis of soft tissue tumours?

Acta Orthop Belg. 2009 Apr

Narvani AA, Tsiridis E, Saifuddin A, Briggs T, Cannon S. Tumour Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, England.

The aim of this study was to compare accuracy of an image guided percutaneous core needle biopsy (PCNB), using ultrasound or computed tomography, to PCNB without image guidance in the diagnosis of palpable soft tissue tumours. One hundred forty patients with a suspected soft tissue sarcoma underwent a percutaneous core needle biopsy with or without image guidance. One hundred eleven patients had subsequent surgical excision. The accuracy of guided PCNB and blind PCNB was calculated by comparing the histological results of the needle biopsy to the surgical specimen. The diagnostic accuracy of blind percutaneous core needle biopsy was 78% (36 of 46 biopsies) and was significantly lower (p < or = 0.025) in comparison to image guided percutaneous core needle biopsy, which was 95% (62 of 65 biopsies). We suggest that image guidance improves the diagnostic accuracy of PCNB especially for small-size deep sited suspected soft tissue tumours.

PMID: 19492564 PubMed - indexed for MEDLINE

External Links

Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes.

Dec 2011

Science Direct

Transbronchial fine needle aspiration biopsy and rapid on-site evaluation in the setting of superior vena cava syndrome.

Nov 2011


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