FNAC and Core Needle Biopsy
On needle aspiration if clear fluid is drawn out the lump is likley to be benign but if bloody it may turn out to be malignant.
If a lump is detected on clinical exam but is not picked up by either a mammogram or a USG then it is highly likely that it is not cancerous. But the lump has to be further probed and the ideal test for that is a fine needle aspiration cytology (FNAC).
This procedure is inexpensive, easy to perform (in skilled hands), requires no advanced preparation, and can be carried out in the doctor’s office.
To aspirate a palpable, suspected cyst, the mass is stabilized between the fingers of one hand and a 22 to 24-gauge needle is inserted using the other hand. Local anesthesia may be used but is not always required.
FNAC is especially valuable in evaluating cystic breast lesions and can be therapeutic if all of the fluid is removed.
If the drawn fluid is clear it is highly unlikely that the lump is cancerous and the lumps shrinks after a while. On the other hand, if the fluid is bloody it must be sent for laboratory examination and pathological analysis. In case of solid mass without fluid, cells may be obtained which can be pathologically evaluated. Less than 30% of the masses biopsied are cancerous.
Triple diagnosis refers to the concurrent use of physical examination, mammography, and skilled FNAC for diagnosing palpable breast lumps. Very few breast cancers are missed using triple diagnosis.
During core needle biopsy a larger needle is used (14 to 18 gauge) as this provides larger material that can be evaluated histologically. Core needle biopsy is used most often for evaluating non-palpable breast lumps. The sensitivity of core needle biopsy is less than FNAC for the diagnosis of palpable carcinoma.
As recent as 2008, scientists discovered that breast cancer cells tend to become more invasive when three specific group of cells occur together in the same region. They are -
- An endothelial cell (a type of cell that lines the blood vessels)
- A perivascular macrophage (a type of immune cell found near blood vessels)
- A tumor cell that produces the protein Mena .