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Small Needle Biopsy and Ovarian Cancer November 16, 2008

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Small Needle Biopsy and Ovarian Cancer

One of the more common biopies done for ovarian cancer is referred to as a small needle biopsy. It may also be referred to as a 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, infection or inflammation. 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 any 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 also accurate enough to diagnose lymphoplasmacytic lymphoma.

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 thepancreas. Pain and infection may occur after a biopdy.

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.

Do not take any aspirin or aspirin substitutes (ibuprofen, Motrin, Advil, Naprosyn) for 1 week before the procedure unless your doctor instructs you otherwise. You may take Tylenol. You will be asked not to eat for a specified time before the procedure. If 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 to 40 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.

Preparation

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.

Positioning

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:

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

Complications

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.

Pain

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).

Infection

Since sterility is maintained throughout the procedure, infection is rare. But should an infection occur, it will be treated with antibiotics.

Bleeding

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

Various types of needle aspiration

This type of biopsy uses a needle to aspirate (draw out) fluid or tissue from a 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.

Techniques

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 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 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.

The Surgery Channel

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