Fine Needle Aspiration Biopsy

Fine needle aspiration biopsy (FNAB) is a diagnostic procedure that is a form of point-of-care testing in anatomic pathology. It is a minimally invasive procedure that uses a fine (<22-gauge) needle to aspirate tissue from mass lesions. Any trained physician can aspirate superficial palpable masses, but the procedure is optimally performed by an experienced cytopathologist who will follow the procedure with a rapid microscopic interpretation. This paper reviews the 10-year experience of the Massachusetts General Hospital's pathology-run FNAB service (1991 to 2001). A total of 5633 FNABs were performed, most from the breast (32%). On average, two-thirds of patients were spared unnecessary surgery due to either a benign biopsy result (64%), or the documentation of a nonsurgical malignancy such as lymphoma or a metastasis (20%). Using only those cases with histologic follow-up, the accuracy rate averaged 94% (1994 to 2000). The vast majority of cytohistologic discrepancies were due to FNAB sampling error (79%). Fine-needle aspiration biopsy is highly accurate and efficient, resulting in rapid triage of patient management in most cases, reducing overall hospital costs, decreasing workload for various hospital departments, and reducing delays in the diagnosis-therapeutic cycle.