is FNA breast biopsy safe?

Hello,

I had an unusual finding on my ultrasound which seems to be a mass of cells within a duct.  The radiologist recommended a fine needle aspiration.  I have read about this procedure, and there seems to be a bit of controversy over whether a biopsy procedure itself can cause cancer cells to spread into the surrounding tissue (this is known as seeding).
Please let me know if this is an actual risk with a fine-needle aspiration breast biopsy.  The area is small and is within a duct.  Would a full surgical excision be safer?

Thank you for your help and expertise.  I'm extremely worried about this due to my family history.

[DrBhumikaMD]

Hi,
The fine needle aspiration cytology procedur is considered safe. It is usually done as an out patient procedure. It is done to rule out malignancy. The chances of seeding are negligible. The results could be inconclusive if the material for diagnosis obtained is small and then a core biopsy or surgical excision biopsy is done. You could discuss with your doctor that you would like to go ahead with a surgical excision biopsy if he recommends. Goodluck.

[jen109]

Hello,

Thank you for your reply.  I've been feeling so anxious about this.  My doctor recommends a fine needle test but said this only has approximately a 50% chance of providing conclusive data.  Does this sound accurate to you?  I'm also worried about seeding.  Have you heard of any cases where a needle biopsy test could cause cancer cells to spread to surrounding tissue or through the body (via blood vessel or lymph nodes).  When you say this risk is negligible, does this mean one in a thousand, or less?  

The ultrasound showed that this could be an intraductal carcinoma.  Do you think a direct surgery would be less risky in terms of spreading any cells?
I really appreciate your input.  I'm seeing a surgeon soon and will need to decide which avenue is best.

Thank you,
Jennifer

[DrBhumikaMD]

Hi,
It is a very safe procedure and therefore done routinely. It would not have been the first choice or such widely used if there was the risk of spread of cancer. It is right as your surgeon says that the chances of getting a confirmed diagnosis are less becuase of the insufficient amunt of tissue obtained. Discuss with your surgeon the merits and demerits of a surgical excision biopsy in your case. Goodluck.

[jen109]

Hello,

Thanks for sharing your expertise.  It's great to have this resource available and I appreciate it.  I'm going to ask the surgeon if he can do an excision biopsy, but the doctor said the surgeon would probably want to do a needle aspiration first as this is less invasive and easier.
I'm still feeling worried about whether there is any risk that a needle aspiration could spread cells into lymph fluid or a blood vessel when the needle is extracted.  Have there been any studies to rule this out?  Is it completely safe to stick a needle into a potential DCIS area that is located quite deep?  If you have further information about if the medical field has studied this question it would really help me feel safer about the procedure.  The articles I've come across on the internet regarding this topic raise alarm, but I'm not sure if they are credible.
Thank you for your help at this very stressful time.  I really appreciate it.
Jennifer

[DrBhumikaMD]

Hi,
A breast biopsy is absolutely safe. It would be better to get a needle aspiration done first as the procedure is an OPD procedure, not painful usually and associated with a low risk of side effects. The disadvantage is that the cells obtained could be in sufficient for the lab to get a confirmed diagnosis. But then, you could get a biopsy done if that happens in your case.

http://www.dcis.info/biopsy.html

This article should help you understand that needle aspiration is a safe procedure and so are other biopsies for breast cancer.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15477859

Even this pubmed article should help clear your doubts.

Hope this helps.
Do let us know about the progress in your case.
Good luck.