Fine-needle aspiration technique for palpable breast lesions

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Using fine needle aspiration in palpable breast lesions will help doctors accurately diagnose malignant or benign tumors and the cause of their formation.... From which is the most appropriate treatment for the patient.

1. Breast lesions

Breast is an organization of glands and stroma. In particular, the glandular organization includes the milk-secreting glands, the milk ducts (which develop strongly during pregnancy and lactation).
Any change of breast organization will cause tumors. Specifically:
At childbearing age and breastfeeding, the most common tumor is breast abscess; During perimenopause and menopause, the lack of ovarian hormones will lead to abnormal symptoms such as breast tenderness, breast density is not uniform. The cause is dystrophy of the breast tissue. Breast diseases if detected and treated early, the prognosis is usually good.

2. Importance of fine needle aspiration in palpable breast lesions

Fine-needle aspiration is considered a diagnostic technique, examining tumors or superficial tumors just under the skin. Under the guidance of ultrasound, the doctor will try to get enough tissue to analyze under the microscope.
This breast biopsy method will make it possible for the patient to take a sample without surgery. In the case of palpable breast lesions, a breast biopsy will assist the doctor in diagnosing whether it is malignant or benign.
The doctor will use a syringe with a needle to insert the needle through the skin into the lesion. After that, it will suck with negative pressure so that the cells from the lesion will enter the needle and then spray the collected fluid on the slide. Next, the doctor will fix, stain, identify the cell morphology as well as the background of the smear under the optical microscope to diagnose the disease.

3. Steps for performing fine needle aspiration in palpable breast lesions

Step 1: Prepare means and chemicals; Step 2: Instruct the patient in the most appropriate position for breast biopsy. Then disinfect the affected area to be aspirated with iodine alcohol; Step 3: Fix the lesion to be poked by using two fingers of the left hand, the right hand holds the needle with the syringe attached. Then use a needle to attach the syringe through the skin to the lesion and then aspirate under negative pressure to allow the puncture fluid to enter the needle lumen; Step 4: Withdraw the needle from the tissue. However, it should be noted that before withdrawing, the negative pressure must be released, and the needle must be withdrawn quickly through the skin. It is possible to aspirate many places on the lesion in case the tumor is > 1.5cm, there is a lot of fluid in the lesion. If there is damage to the areola or nipple, a local anesthetic should be given before the puncture; Step 5: Remove the needle from the syringe and pull the plunger down, the purpose is to get air into the syringe to create pressure. Then, inserting the needle into the syringe, the doctor quickly spits out the pre-recorded slides. Finally, use another slide to spread the patient on the slides with the patient; Step 6: Fixed the smear by cytological fixation methods; Step 7: Stain the slides with staining methods such as Giemsa, Papanicolaou, HE... Step 8: The final step of this breast biopsy method is to identify the results on the optical microscope. Note: The smear after aspiration must have the correct cellular components of the damaged tissue and the composition of the lesion to be determined. The plates also need to be spread thinly and evenly. Well preserved tissue morphology and cell damage. At the same time, cells also need to be clearly colored, clearly distinguishing morphology.

4. Errors and how to handle them

Fine needle aspiration of palpable breast lesions is subject to certain errors. Common errors and treatment are as follows:
Few or no cells are obtained at the site of injury: The cause is because the needle is deep or shallow, so the operator needs to pierce the needle. needle hit injury. In addition, little or no removal of lesional cells may be due to poor immobilization of the puncture site during aspiration, so it is necessary to press the finger firmly to hold the lesion to be punctured. Too many red blood cells: In case there are too many red blood cells, do not change the direction of the needle when the needle has penetrated the tissue, the purpose is to avoid bleeding when pricking or inserting 1 more needle in another location when there is a lot of blood. Spread sheet is too thick or pulled too hard: When the slide is too thick, it can cause cells to pile up or be stretched, crushed. In this case, it is necessary to spray a sufficient amount on each slide, then gently and evenly spread it. Poor fixation: Poor fixation will cause the cells to degenerate, thereby not recognizing the nuclear and cytoplasmic morphology. In this case, it is necessary to repeat the test, and fix it immediately after the smear is evenly spread. Poorly stained cells: If the cells are poorly stained, adequate staining is required and the slide is fixed well and the dye is examined. Uncooperative patient: Persuading and explaining to the patient. Small bleeding at the puncture site: The doctor needs a compression bandage at the bleeding site. The puncture fluid is dry in the needle or on the glass slide before spreading: In this case, the person performing the procedure needs to quickly aspirate, quickly spit out the slide and spread it right away. Physiological saline can also be pumped to wash the needle to obtain fluid as a smear. Aspiration to a site outside the lesion such as a blood vessel or nerve,...: Need to withdraw the needle immediately, then fix the position to be aspirated and aspirate again. Pneumothorax: The cause of a pneumothorax is the passage of a needle through the lung. Therefore, when aspirating fluid, it is necessary to be at the angle of the needle, not at a straight angle. It is also possible to immobilize the puncture block to rest on the ribs and ask the patient not to fast before the procedure. Shock: If the patient is stunned during or after the puncture, it is necessary to quickly put the patient down on the bed and administer anti-shock treatment. To ensure safety and get the most accurate diagnosis of palpable breast lesions, patients need to go to a reputable hospital to conduct fine needle aspiration under ultrasound guidance. Currently, Vinmec International General Hospital is one of the leading prestigious hospitals in the country, trusted by a large number of patients for medical examination and treatment. Not only the physical system, modern equipment: 6 ultrasound rooms, 4 DR X-ray rooms (1 full-axis machine, 1 light machine, 1 general machine and 1 mammography machine) , 2 DR portable X-ray machines, 2 multi-row CT scanner rooms (1 128 rows and 1 16 arrays), 2 Magnetic resonance imaging rooms (1 3 Tesla and 1 1.5 Tesla), 1 room for 2 levels of interventional angiography and 1 room to measure bone mineral density.... Vinmec is also the place to gather a team of experienced doctors and nurses who will greatly assist in diagnosis and detection. early signs of abnormality in the patient's body. In particular, with a space designed according to 5-star hotel standards, Vinmec ensures to bring the patient the most comfort, friendliness and peace of mind.

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