Fine needle aspiration and Core biopsy

Fine-needle aspiration (FNA) is a method of collecting cells from organs in the body to look for signs of cancer, infection, or other conditions. The radiologist inserts a thin needle into a lump and withdraws a sample of cells or fluid. The material is then examined under a microscope. We usually have a pathologist present for FNA procedures.

The radiologist will wipe the area with rubbing alcohol or iodine. In most cases, you will receive an injection of local anaesthetic to numb the area of skin and overlying tissue where the needle will be inserted. Your doctor will hold the lump steady with one hand and insert a thin needle (attached to a syringe) into the lump. He or she may move the needle in and out of the area to make sure to get enough tissue or fluid for the biopsy. The process takes a few seconds to a few minutes.

In most cases an imaging modality, such as a CT scanning, ultrasound, or fluoroscopy will be used to guide the radiologist to determine exactly where to place the needle and perform the biopsy. If the lump is a cyst, the fluid is removed, and the lump usually resolves.

Fine-needle aspiration may be the only test you need to find out whether a lump is cancerous. But in some cases you may need to have another procedure, such as a core needle biopsy or an open biopsy (done by the surgeons). During a core needle biopsy, you will have local anaesthetic to numb the area. The doctor places the core needle (which is larger than the aspiration needle) into the lump. He or she takes out a thin section of tissue (about the size of a pencil lead), rather than a few cells.

You should inform your doctor about all medications that you are taking and whether you have any allergies. Your physician may advise you to stop taking aspirin, non-steroidal anti-inflammatory drugs or a blood thinner for a specified period of time before your procedure. Your blood will be tested to determine whether your blood clots normally.

How will it feel?

If you receive a local anaesthetic, you may feel a brief sting when it is injected. You also may feel some pressure when the biopsy needle is inserted. The amount of discomfort will depend on how much pain you feel from needles, the part of your body involved, and the skill of the doctor. The site of the fine-needle aspiration may be sore for a few days, and you may have a bruise. You should be able to return to work on the same day or the next day. Your radiologist will apply pressure to the aspiration site to prevent bleeding and put an adhesive bandage on it. He or she may recommend that you take a mild pain reliever if you have discomfort when you get home. Keep the area dry for 24 hours.

Contact your doctor if you have bleeding, redness, swelling, or a high fever over the next few days.

Please note that you need to sign a consent form as it is a surgical procedure. Any surgical procedure does have a risk factor for example haemorrhage or pneumothorax in the case of biopsies or FNA.

What is a lumbar puncture?

A lumbar puncture, also called a spinal tap, is a procedure in which the fluid surrounding the spinal cord (called the cerebrospinal fluid or CSF) is withdrawn through a needle and examined in a laboratory. The CSF collected contains glucose (sugar), proteins and other substances that are also found in the blood. Testing the CSF can help in the diagnosis of disorders of the central nervous system that may involve the brain, spinal cord or their coverings (meninges).

This procedure may be performed to:

How is a lumbar puncture done?

Using sterile technique, universal precautions and local anaesthetic, a thin needle is advanced through the skin to the target tissues in the lumbar spine. The target tissues are precisely localized by advancing the needle under image guidance (fluoroscopy) and confirmed with free flow of spinal fluid from the needle. After the appropriate amount of fluid is collected, the needle is removed, skin cleaned and a standard band-aid applied.

In our experience, lying in bed for 4 hours after the procedure reduces the risk of a post-lumbar puncture headache, which is the most common complication.

Facet block injections are performed in our departments. Facet joints are small joints at each segment of the spine that provide stability and help guide motion. These facet joints can become painful due to arthritis of the spine, a back injury or mechanical stress to the back. A facet joint injection is a minimally invasive procedure that involves injecting an anaesthetic along with a time-release cortisone or steroid medication, which can anaesthetise the facet joints and block the pain. The needle is guided to the appropriate joint by using fluoroscopy or computed tomography (CT).

A facet joint block is typically performed to decrease inflammation, provide pain relief, help the patient to better tolerate a physical therapy routine or rehabilitation exercises and help physicians determine the cause for the patient’s back pain.

Synovitis or inflammation of the joint lining is a common cause of joint pain. In such cases, injection of a corticosteroid and/or local anaesthetic dirctly into the joint or space next to the joint (bursa) can help decrease inflammation and relieve pain. Tendon injections are administered into the tendon sheath around the tendon. These therapeutic and diagnostic joint injections are preformed with the aid of ultrasound guidance. Common sites of injection are the shoulders, knees, hips and wrists.

Pain relief from such injections varies amongst patients. The relief is usually short to medium term, ranging from weeks to months.

What is Percutaneous Abscess Drainage?

An abscess is an infected collection of fluid in the body. In general, people who have an abscess will experience fever and pain in the approximate location of the area that is involved. Patients with these symptoms will undergo an x-ray, CT scan or an ultrasound exam, to assist in making the correct diagnosis. Once the diagnosis of an abscess has been made, an assessment is made by your physician and an interventional radiologist to decide which therapy is appropriate.

As long as it is deemed safe, percutaneous abscess drainage, a practical approach with relatively simple devices and techniques, may yield a high success rate with few complications.

How the Test is Performed

Your blood will be tested to determine whether your blood clots normally. During the procedure, the radiologist places a thin needle into the fluid using imaging guidance such as ultrasound or computed tomography (CT) scanning. The needle is used to guide a drainage tube into the abscess. Usually, the drainage tube is left in place to drain the abscess fluid. Occasionally, abscesses that cannot be safely treated by percutaneous drainage may require more extensive surgical drainage in the operating room.

How to Prepare for the Test

You should inform your doctor about all medications that you are taking and whether you have any allergies. Your physician may advise you to stop taking aspirin, non-steroidal anti-inflammatory drugs or a blood thinner for a specified period of time before your procedure.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

You may be instructed to not eat or drink anything for several hours before your procedure.

You will be given a gown to wear during the procedure.

You should plan to stay at the hospital following your procedure.

What is a Nephrostomy?

Urine is transferred from the kidneys to the bladder via thin tubes known as ureters. If a ureter becomes obstructed (by stones, tumour, clot or inflammation), urine flow is blocked, the urine becomes trapped in the kidney and the kidney swells up. This is referred to as hydronephrosis.  If left untreated, this condition can progress to severe kidney infection and loss of renal function.

There are two methods that can be used to restore flow or drainage of urine, the first is via a ureteric stent and the second is via a nephrostomy. Usually the urologist will attempt to insert a ureteric stent via the bladder, into the ureter and past the obstruction. If successful, urine flow will be re-established. When the urologist is unsuccessful, a nephrostomy is the next alternative.

How the Test is Performed

Your blood will be tested to determine whether your blood clots normally. During a nephrostomy, a needle is placed through the skin on your back into the collecting system of the kidney, using fluoroscopic and ultrasound guidance. The needle is used to guide a drainage tube into the kidney. The needle is then removed and the drainage tube is connected to an external drainage bag. After a few days of drainage, the interventional radiologist can then attempt to place a ureteric stent by inserting a guidewire via the nephrostomy, down the ureter and past the obstruction to the bladder. The stent is placed over the guidewire and the guidewire is withdrawn. If successful, the nephrostomy can be removed later.

How to Prepare for the Test

You should inform your doctor about all medications that you are taking and whether you have any allergies. Your physician may advise you to stop taking aspirin, non-steroidal anti-inflammatory drugs or a blood thinner for a specified period of time before your procedure.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant.

You may be instructed to not eat or drink anything for several hours before your procedure.

You will be given a gown to wear during the procedure.

You should plan to stay at the hospital following your procedure.