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Fine needle aspiration of breast masses is a type of biopsy performed using a small needle to obtain samples of tissue and fluid from solid or cystic breast lesions. It is one of the many different modalities for diagnosing breast masses. This activity reviews the indications, contraindications, and technique involved in performing fine needle aspiration of breast masses and highlights the role of the interprofessional team in the care of patients undergoing this procedure. Objectives: Explain the indications for fine needle aspiration of breast masses. Describe the technique for performing fine needle aspiration of breast masses. Outline the contraindications to fine needle aspiration of breast masses. Employ a structured interprofessional team approach to provide effective care to patients undergoing fine needle aspiration of breast masses. Access free multiple choice questions on this topic.

Fine needle aspiration (FNA) is a type of biopsy that is performed with a small (21 to 25 gauge) needle to obtain samples of tissue and fluid from solid or cystic breast lesions. It is one of the many different modalities for diagnosing breast masses outside of formal excision. Other methods include core needle biopsy (CNB) and Mammotome vacuum-assisted stereotactic biopsy. FNA and CNB can be performed with the assistance of imaging guidance (namely ultrasound) or done “free-hand” in the case of palpable breast lesions. Vacuum-assisted biopsy is performed with sonography, mammography, or MRI assistance.[1][2][3][4] Controversy exists regarding which is the preferred method for diagnosing, as each has strengths and weaknesses, and their incorporation into the breast surgeon’s practice varies. FNA has many advantages and potential uses making it a popular option for the diagnosis and treatment of certain breast lesions.

Even though FNA appears to be a simple procedure, a number of complications can occur which include the following: Bruising Hematoma Infection Pneumothorax if the needle is advanced deep in the chest area Pain So far there is no evidence to show that FNA causes seeding of breast cancer or worsens survival or prognosis. More important, FNA does not affect the number of falsely positive mammograms as long as the radiologist has prior information of where the FNA was performed.

FNA is a very common procedure done by the primary care provider, nurse practitioner, internist, radiologist, surgeon, and many others. The key is to know the anatomy and potential complications. It is also important to know that FNA has a low yield and thus a negative result should never be accepted if there is high suspicion of something more sinister. In such scenarios, it is important to communicate with other professionals on the best workup of the patient.[12] Performing a FNA requires an interprofessional approach. The nurse should be familiar with the procedure, preparation, and technique and should support the surgeon during the procedure making sure that sterile technique is maintained. Often surgeon may need assistance with positioning the patient or anatomical position of the breast for the procedure. In addition, films need to be available and often will require the nurse to assist in holding them during the procedure in locating the mass. After the procedure, the nurse must monitor the patient's vital signs and report back to the surgeon if any untoward complications develop. Further, on discharge, the nurse should provide instructions to the patient and if it is unclear the patient is not understanding the followup, the nurse should consult the surgeon to assist in educating the patient. The patient should be monitored by the nurse for signs of infection post-procedure and again the surgeon contacted if there are concerns. Only through an interprofessional approach to this procedure will optimal outcomes be achieved. [Level V]

Vital signs Wound checks Signs of infection Signs or symptoms of an allergic reaction to medications used pre and postoperatively Any signs of untoward events should be reported to the surgeon and interprofessional team.