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Fine-Needle Aspiration of Solid Masses

  • Bruno D. Fornage
Chapter
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Abstract

This chapter discusses the techniques of, indications for, and expected results of ultrasound (US)-guided fine-needle aspiration (FNA) of the most common solid breast masses. Numerous benign solid masses can be sampled with FNA. For some of them, a specific diagnosis can be established cytopathologically. The role of FNA in the diagnosis of malignancy is redefined. While FNA has been replaced by core-needle biopsy in the workup of a suspicious mass in the breast because of its inability to diagnose invasiveness of a malignant tumor, FNA still plays a significant role whenever the simple presence of a malignant tumor must be confirmed, e.g., to confirm multifocality or multicentricity of a known cancer, a local recurrence, a metastasis to the breast from a known extramammary malignancy, or the involvement of the breast by lymphoma or leukemia.

Keywords

Fibroadenoma Fibrocystic changes Fat necrosis Mastitis Cellulitis Intramammary lymph node Intraductal papilloma Sebaceous cyst Breast carcinoma Multifocality Multicentricity Local recurrence Metastasis from extramammary malignancy Lymphoma Leukemia 

Supplementary material

Video 8.1

Sampling of a fibroadenoma during a fine-needle aspiration. Note the changes in the direction of the needle to augment the volume of sampled tissue (MOV 2056 kb)

Video 8.2

Sampling of a minute fibroadenoma in a 57-year-old woman during a fine-needle aspiration. The needle tip remains within the boundaries of the 8- × 6- × 3-mm, firm nodule during the entire aspiration (MP4 53658 kb)

Video 8.3

“Complex” fibroadenoma with irregular margins, taller-than-wide shape, and calcifications. A core-needle biopsy was performed instead of a fine-needle aspiration to obtain a definitive diagnosis of fibroadenoma. First, the cutting needle is used to “tease” the lesion to test its firmness and mobility in the fatty environment, and then the needle is fired through the lesion (MP4 14689 kb)

Video 8.4

Fat lobule mimicking a benign solid nodule. Swiveling the transducer makes a communication appear between the pseudolesion and the subcutaneous fat layer (MOV 10542 kb)

Video 8.5

Fat lobule mimicking a benign solid nodule. Rotating the transducer on its axis allows demonstration of the connection of the fat lobule to the subcutaneous fat layer (MOV 11619 kb)

Video 8.6

Fat necrosis. Fine-needle aspiration is performed on a 6-mm, indeterminate, palpable nodule in the upper chest wall in a patient who underwent mastectomy and radiation therapy for invasive breast cancer (see also Fig. 8.8) (MOV 3530 kb)

Video 8.7

Fat necrosis. Dynamic examination with compression maneuvers shows the induration of the echogenic fat and its lack of compressibility compared with the surrounding fat (see also Fig. 8.11) (MOV 5502 kb)

Video 8.8

Fat necrosis. Videoclip shows extensive multidirectional sampling of the area of fat necrosis during fine-needle aspiration. Note that the small cystic area could not be aspirated (see also Fig. 8.11) (MOV 11711 kb)

Video 8.9

Fat necrosis. Dynamic examination using lateral motion of the probe shows the deformability of the lesion, which is not consistent with malignancy (see also Fig. 8.12) (MOV 3820 kb)

Video 8.10

Fine-needle aspiration of a benign intramammary lymph node in the upper-outer quadrant of the right breast. Transverse sonogram shows the needle passing beneath the lateral thoracic vessels and lifting them slightly to reach the node. The constant real-time visibility of the needle allows the proceduralist to guide it within a few millimeters of structures that need to be avoided (see also Fig. 8.17) (MOV 6644 kb)

Video 8.11

Videoclip 8.11. Color Doppler sonography performed prior to the fine-needle aspiration of a 5-mm intramammary lymph node metastasis in the right axillary tail shows flow in the lateral thoracic artery, which courses around the node (MP4 8176 kb)

Video 8.12

Hemangioma. Extensive sampling of the 1.4-cm mass with fine-needle aspiration yielded only blood, and a core-needle biopsy was required to establish the diagnosis of hemangioma (see also Fig. 8.22) (MP4 11014 kb)

Video 8.13

Ruptured sebaceous cyst. Compression maneuver shows the rim of echogenic, indurated, non-compressible inflamed fat around the cyst (see also Fig. 8.23) (MOV 4860 kb)

Video 8.14

Typical sebaceous cyst. Sonography shows smooth indentation of the deep dermis and internal mildly echogenic debris. Power Doppler imaging shows what appear to be internal Doppler signals, which can be misinterpreted as true internal vascularity, raising suspicion of a malignant neoplasm. However, switching from power Doppler to color Doppler mode clearly shows the twinkling artifacts associated with the concretions and debris in the cyst (see Chap.  1). (MOV 5256 kb)

Video 8.15

Power Doppler examination shows increased vascularity in a 5-mm, PET-detected invasive ductal carcinoma (see also Fig. 8.28) (MOV 3312 kb)

Video 8.16

US-guided fine-needle aspiration of a 5-mm invasive ductal carcinoma is done first to confirm proper identification of the target lesion detected on the PET-CT scan but mammographically occult prior to performing the required core-needle biopsy (CNB). The tip of the fine needle does not leave the boundaries of the small lesion during the entire sampling. A single pass with a 20-gauge needle yielded enough material to establish the diagnosis of breast carcinoma, grade 2; this was confirmed by the subsequent CNB (see also Fig. 8.28) (MOV 6931 kb)

Video 8.17

Fine-needle aspiration of a 6-mm, taller-than-wide nodule representing a second focus of malignancy about 2 cm from the main tumor confirms the cancer’s bifocality with a single pass (see also Fig. 8.30) (MOV 1877 kb)

Video 8.18

Fine-needle aspiration of a 5-mm cancer. Videoclip shows the exhaustive sampling of the 5-mm nodule during the short procedure. A single pass was sufficient to establish the cytological diagnosis of malignancy (see also Fig. 8.32) (MOV 7021 kb)

Video 8.19

Patient with US-detected multifocal recurrence from a micropapillary cancer treated 10 years ago. Videoclip shows the FNA sampling of the smallest nodule, measuring only 2 mm in diameter (see also Fig. 8.38) (MP4 7379 kb)

Video 8.20

Patient with US-detected multifocal recurrence from a micropapillary cancer treated 10 years ago. Videoclip shows the FNA sampling of the largest nodule, measuring 7 mm in longest diameter (see also Fig. 8.38) (MP4 7347 kb)

Video 8.21

Small local recurrence 3 years after mastectomy and reconstruction for breast cancer. Videoclip shows the FNA sampling of the 5-mm recurrence close to the prosthesis. A single pass yielded sufficient material to confirm the diagnosis or local recurrence (see also Fig. 8.39) (MOV 2436 kb)

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bruno D. Fornage
    • 1
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA

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