What Is Breast Needle Aspiration: Difference Between Needle Aspiration And Needle Biopsy, Interpretation Of Results, Risk

Generally, this test is performed to analyze the cells that make up a lump or an area of ​​breast tissue considered suspicious by radiological ( ultrasound and mammography ) and clinical ( senological examination ) diagnosis.

The objective of the needle aspiration is to establish the nature and characteristics of the breast alteration in place, in order to plan a correct therapeutic procedure or perform further diagnostic tests .
The technique is minimally invasive and involves the collection of a sample of cells or liquid to be subjected to cytological examination. The withdrawal is performed under ultrasound guidance, introducing a very thin needle into the breast, until it reaches the suspicious formation, from which part of the content is collected to be subjected to subsequent laboratory analyses.

Based on the outcome of the cytological examination, the specialist doctor will decide whether to proceed with further investigations and/or will establish the most appropriate therapeutic course for the case.
The method is performed with a fine needle (similar to that of a normal injection) and consists in taking a sample of cells or liquid from an area or a lump considered suspicious. Subsequently, the collected material is sent to the pathologist for cytological study (ie of the cells) in the laboratory.
The procedure is complementary to the ultrasound examination of the breastand mammography: in case of suspected neoplastic formations, the cytological sampling allows to establish its nature and characteristics, excluding or confirming the diagnosis of malignant breast tumor .
Breast needle aspiration therefore allows for a more in-depth diagnostic classification: the cytological examination evaluates all the possible pathological aspects of the single cells present in the collected sample.
In most cases, the cytological sample is performed under ultrasound (ie with the use of ultrasound) or radiographic (in the case of mammography) guidance, to better locate the lesion deemed suspicious and reach the target exactly.

What Did You Want To Find Out?

The needle aspiration allows to discriminate a benign alteration of the breast (as in the case of cysts and fibroadenomas ) from a breast lesion of a malignant nature ( carcinoma or other tumours ).
Usually, the cytological sample is performed following breast ultrasound and/or mammography, in the event that these investigations have highlighted suspicious lesions and a more in-depth diagnostic framework is required.

How Is It Done?

Fine-needle aspiration consists of taking breast tissue samples with a hollow needle, similar in caliber to that of a normal syringe.

During the exam, the needle is inserted into the breast through the skin until it reaches the nodular changes or suspicious areas to be examined.
Fine needle aspiration can be performed with the support of ultrasound guidance or, if the breast nodules are palpable, without the aid of imaging tools.

Withdrawal takes a few minutes. The patient is made to lie on her back on a bed, with her arms raised and her breasts uncovered, in a relaxed and easy position for the doctor to perform the procedure. An ultrasound probe locates the lesion and the needle entry point is chosen.
The skin is disinfected and sampling begins: when the area is reached, aspiration begins, which allows a small fraction of cells to be collected. During this maneuver, the needle is moved repeatedly within the lesion (back and forth, in multiple directions) to sample the most suspicious areas.
The cellular material thus collected is placed on two or more slides, which will then be treated and studied under the microscope by the specialist in pathological anatomy, who will define the nature of the lesion.

The result is usually available within a few days.

When Is It Indicated?

• In case of a lump , a cyst , a mass or an area of ​​breast tissue that is suspicious and not better defined, needle aspiration can be indicated to study the cells that compose it and better understand their nature. This outpatient procedure therefore integrates the breast examination, breast ultrasound and/or mammography, in order to exclude any diagnostic doubts and have the most precise response possible.
• Fine needle aspiration is also performed on known tumors, to monitor the effect of the treatment or to obtain samples to be subjected to further diagnostic investigations.
• The method can also be used for needle aspiration of suspicious lymph nodes both in the axillary area and in other locations.
• Breast needle aspiration can also be used for therapeutic purposes , for example to drain abscesses or to empty the liquid contained within breast cysts , when these cause discomfort in the patient.
• This procedure may also be indicated for performing preoperative centering . This involves the introduction of a thin needle, through which a metal wire can be positioned (which will then be removed during surgery) or a few drops of a radioactive tracer are injected, in order to mark the site of the lesion that must be removed by the surgeon.

Difference Between Needle Aspiration And Needle Biopsy

Fine-needle biopsy and fine-needle aspiration of the breast are procedures that have the same purpose: to take a small sample of tissue or cells to carry out an examination under the microscope and evaluate their nature.
The choice of the technique to be used is made by the specialist doctor on the basis of various factors, such as the characteristics, dimensions or location of the formation to be analysed.
A breast needle biopsy allows a small portion of tissue to be taken from an area deemed suspicious. Compared to fine needle aspiration, this technique uses a larger caliber needle for the removal of a greater quantity of material from the nodule (called frustule) and is generally performed under local anesthesia.
The substantial difference between the two techniques is, therefore, the greater invasiveness of needle biopsy, which, however, in some situations is necessary to obtain greater diagnostic reliability.

Interpretation Of Results

C1 = Inadequate/Unrepresentative

The description indicates a needle aspiration that is technically non-optimal (inadequate) or which includes a too low number of epithelial cells (not representative) for the formulation of the cytological diagnosis.

C2 = Benign finding

The needle aspiration sample is adequate and certainly benign cells are found. Sometimes, it is also possible to formulate the specific diagnosis of the lesion such as, for example, in the case of cyst, fibroadenoma , ductal ectasia and mastitis .

C3 = Atypia in lesion probably benign

The cytological analysis of the needle aspiration material revealed the characteristics of a benign lesion, but some atypic characters are present. In this case, the result must be compared with the other tests performed (breast examination, ultrasound or mammography) in order to make a decision. The doctor can therefore indicate further tests for the correct definition of the pathological condition.

C4 = Suspicion of malignancy

The fine-needle aspiration of the breast shows a sample with characteristics that suggest the probable presence of a carcinoma. In this case, however, the diagnosis of malignancy is not definitive and, often, further tests are necessary.

C5 = Malignant finding

Cytological analysis of the fine-needle aspiration material indicates the presence of a carcinoma or other malignant tumors . This means that cells with unequivocal characteristics of malignancy were found in the sample.

Is Preparation Necessary?

Before fine-needle aspiration of the breast, no special preparation is required. Even the use of local anesthesia is generally not necessary, as the pain felt during the procedure is modest.

Are There Any Contraindications?

Breast needle aspiration is a simple, safe and generally well tolerated technique.
The sampling is very rapid, minimally invasive and guided precisely by ultrasound instruments (or radiographic, in the case of mammography).
Breast needle aspiration does not require anesthesia (except in particular cases) or hospitalization (the person can immediately return to his or her home and/or activity without needing to be accompanied).
Rarely, it is possible to feel a slight discomfort due to the appearance of a possible hematoma (i.e. a collection of blood at the sampling site), which is relieved with the application of simple ice packs and, usually, is reabsorbed in a few days .

Risks

The risks associated with needle aspiration of the breast are the same as with a normal intramuscular injection , i.e. infection (very rare, since all the rules for operating in sterile conditions are respected ) and bleeding (more frequent in areas where the breast is richer in superficial venous plexuses). Sometimes, a modest tenderness at the sampling site
is reported for a few hours. A rare but described event is the accidental needle puncture of the pleura of a lung ( pneumothorax ); if so, appropriate medical treatment is required.

During a fine needle aspiration, it was demonstrated that there is no risk of distant dissemination of neoplastic cells.