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Fine needle biopsy, non-aspiration technique


Medical editor Bjørn Risberg MD
Pathologist
Oslo University Hospital

General

Fine needle biopsy is a simple and cost-effective method causing little discomfort for the patient.

It can be used for palpable tumors in patients with cancer or where possible spreading can be confirmed or excluded. It can also be used on patients without a previous cancer diagnosis, either to achieve a diagnosis or to determine further relevant examinations. This method gives the quickest result/diagnosis.

Indications

  • Fine needle biopsy is performed on palpable surface nodes

Goal

  • To obtain a specimen which provides a basis for making a diagnosis.


Equipment

  • 1 x 20 ml syringe filled with air
  • Cannulas, size depending on lesion
  • Colorless chlorhexidine, 1 mg/ml
  • Gloves
  • 3–4 slides
  • 3–4 cover glasses
  • RPMI-medium
  • Labels to mark slides and RPMI-glass
  • Staining solutions (haemacolor)
  • Water for rinsing
  • 6 tubs for staining/rinsing
  • Gauze pads
  • Bandage
  • Fan or hairdryer for drying specimens
  • Microscope, 10X or 20X objective
  • Examination table

Preparation

Explain to the patient precisely what will happen and why.

Implementation

The patient should sit or lie on the examination table - whatever gives the best result. 

  • Wash the area for puncture with colorless chlorhexidine 1 mg/ml.
  • Allow the skin to dry.
  • Palpate the node/tumor.
  • Find the best position for puncturing.
  • Fix the lymph node/tumor between your fingers.
  • Puncture quickly through the skin with the cannula.
  • Move the cannula back and forth into the node in different directions (approximately 2–3 movements/second).
  • When (after 3–4 seconds) the material is visible in the upper part of the cannula passage, the cannula is retrieved.
  • Put a pressure on the point of puncture if needed.
  • Connect the cannula to the syringe filled with air.
  • Carefully spray the specimen from the cannula onto the slide.
  • If the suspicion of lymphoma or tumor is difficult to confirm, repuncture and put some material in the RPMI medium from a new puncture (for flow cytometry/molecular examination etc. Which type of examination is determined after microscopic examination.)
  • Smear the specimen on the slide.
  • Dry the specimen under a fan or hairdryer.
  • Staining: fixation fluid with methanol + haemacolour + rinsing in water  
    • 5 dips in fixation fluid. Allow the solution to drip off on paper. 
    • 3 dips in staining solution 1.
    • 6 dips in staining solution 2. Allow the solution to drip off onto paper.
    • Rinse in two tubs with clean water.
  • Examine the specimen under the microscope with a 10X or 20X objective.

 

 


Observations

  • After the puncture, slight bleeding may occur.
  • Other complications are very rare.

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