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Subject: Fine-Needle Aspiration of the Breast
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Focal lesions extending progressively in all directions
Lesions adherent (fixed) to the deep chest wall fascia
Lesions extending to the skin and producing retraction and dimpling
Lymphatic blockage producing skin thickening, lymphedema, and peau d’orange (orange peel) changes
Main ductal involvement producing nipple retraction
Widespread infiltration of the breast producing acute redness, swelling, and tenderness (i.e., inflammatory carcinoma)
Appendix A: Informed Consent
Appendix C: Bacterial Endocarditis Prevention Recommendations
Appendix E: Skin Preparation Recommendations
Appendix I: Suggested Tray for Soft Tissue Aspiration and Injection Procedures
Two sterile plain evacuated blood tubes
Needles, 21, 22, 23 gauge
Syringe of appropriate size
Pistol grip device if desired
Slides with frosted ends (three or four)
Glass cover slips or extra slides for smearing the specimens
Gauze pads, 4 × 4 inches
Alcohol, povidone-iodine, or chlorhexidine swabs
Syringe (1 mL) with 30-gauge needle and 1% lidocaine for anesthesia
Presence of a palpable mass in the breast
Absence of a qualified cytopathologist capable of interpretation of the FNA slides
Lack of clinician training with the procedure
Severely immunocompromised patients (relative contraindication)
PITFALL: Avoid injecting air because this may cause a vascular air embolus.
PITFALL: Use care to avoid putting the needle tip through the breast and into the examiner’s hand.
PITFALL: Isolating the lesion by using the nondominant hand to press the lesion down against the chest wall increases the risk of a pneumothorax.
PITFALL: Do not let the needle come out of the skin while a vacuum is present in the syringe. This causes the sample to be drawn up into the syringe, where it may be difficult to remove.
PITFALL: It is not necessary to change the angle of the needle during the FNA, because it is the passage of the needle into the center of a lesion and the subsequent back-and-forth motion of the needle tip around the initial needle pass that allow shaved fragments of cells to enter the syringe. Moving the needle tip off this initial path in the center of the lesion often results in the needle moving out of the lesion and causes undue errors.
The major risk of the FNA procedure is failure to place the needle tip into the lesion. Significant complications of FNA, such as pneumothorax, are rare. Some patients experience mild soreness, hematoma formation, and skin discoloration. The patient with controlled anticoagulation may safely undergo FNA if parameters are in the therapeutic range and adequate site compression is used after the procedure to avoid hematoma. All patients undergoing FNA of breast lesions should wear a supportive brassiere after the procedure.
The Cameco syringe pistol ($286) is available from Precision Dynamics Corporation, 13880 Del Sur Street, San Fernando, CA 91340-3490. Phone: 1-800-772-1122. Web site: http://www.pdcorp.com, although this item is not on their Web site.
Morton Medical Ltd., 262a Fulham Road, London SW10 9EL. Phone, UK only: 0207 352 1297; phone outside of the UK: +44 207 352 1297. Web site: http://www.mortonhealthcare.co.uk/products_index.htm