Breast Fine Needle Aspiration (FNA)

Authors:  Dr Natacha Borecky*
                        A/Prof Liz Wylie*

What are the prerequisites for having a breast FNA done?

In symptomatic women, a preliminary careful clinical examination and imaging investigation (ultrasound and/or mammograms) is necessary before a breast FNA. Ultrasound examination alone is recommended for young and pregnant women. For older symptomatic or asymptomatic women, bilateral mammograms are needed before any breast FNA and can be followed by complementary mammographic work up and/or ultrasound examination if necessary. There is no need to stop medication (e.g. aspirin or anticoagulant medication) before a breast FNA.

It is important for the referring doctor to provide all the relevant information (clinical findings, nature and duration of the symptoms, exact location of the lesion, personal and family history for breast cancer, presence of breast implant(s), anticoagulant medication, use of HRT, previous radiotherapy/chemotherapy) on the request form for the specialist doctor who will perform the breast FNA and for the cytologist who will interpret the results.

What are the absolute contraindications for a breast FNA?

There are no absolute contraindications for breast FNA.

What are the relative contraindications for a breast FNA?

Needle phobia, previous vasovagal episode, or inability to cooperate (due to dementia, physical disability or stroke) can make the procedure technically difficult or impossible.

Breast FNA is more difficult in the presence of breast implant. There is a minimal risk of damaging the implant, depending of the location of the breast lesion, but there is no contraindication for a breast FNA. Very small or very large breasts may make breast FNA technically impossible.

Anticoagulant medications (aspirin, warfarin or PIavix) are not contraindicated for a Breast FNA, but the specialist doctor who will perform the test needs to be aware of any of anticoagulant medication as there is more risk of bleeding and more compression will be required after the FNA to avoid a haematoma.

What are the adverse effects of a breast FNA?

A bruise can appear after the procedure, especially if the patient is taking anticoagulant medication (aspirin, warfarin, PIavix). Minimal bleeding and bruising and rarely a haematoma may happen during or after the procedure. Good compression after the procedure is usually enough to avoid any severe bleeding.
There is minimal risk of infection. Breast pain after FNA is uncommon and can be relieved by simple analgesic (paracetamol or Panadol, no aspirin).

Pneumothorax (perforation of the lung cover causing collapse of the lung) is extremely rare.

Breast implant perforation can happen but is a rare complication of a breast FNA.

Epithelium displacement and tumour cell dissemination along the needle tract may occur after any needle biopsy but are more common with larger needle biopsy (core) than with FNA. However the significance and implication of this rare complication is not actually known.

Are there alternative imaging tests, interventions or surgical procedures to a breast FNA?

Inconclusive or non-diagnostic breast FNA, false positive and false negative breast FNA can happen and are more common with a breast FNA than with a larger core biopsy.

Breast FNA can be inconclusive, non-diagnostic or false negative for sampling error, inadequate specimen or because of the nature of the lesion (fibrotic lesion, micro-calcifications).

Distinguishing between ductal carcinoma in situ (DCIS) and invasive carcinoma is not possible on cytological examination. Cytological results need to be accurately correlated with the imaging and clinical findings (“triple test”).

Useful websites about breast FNA:

A reference book: Breast fine needle aspiration cytology and core biopsy: a guide for practice:
canceraustralia.gov.au/publications-resources/cancer-australia-publications/breast-fine-needle-aspiration-cytology-and-core

*The author has no conflict of interest with this topic.

Page last modified on 29/3/2017.

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