Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach

Abstract

Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.

Value of combined use of fine‐needle aspiration and core needle biopsy in palpable breast tumors performed by pathologist: Institut Curie experience

“…Moreover, immunocytochemistry, immunohistochemistry on cell blocks, and other ancillary studies gave confidence to the clinicians to decide the best treatment strategies. 36,37 To increase the diagnostic precision even more the multidisciplinary approach with triple test should be use to investigate all breast tumors. This test combines FNA/CNB, radiological imaging, and clinical examination and to some extent overcomes the limitations of each individual method.…”

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“…In diagnosis of selected tumor mass, FNA with cytofoam-core replaces the tissue characteristics, achieving reliable diagnostic results, saving time and resources for the healthcare team and less discomfort for patients [3].…”

Comparison of tru-cut biopsy and fine-needle aspiration cytology in an experimental alcoholic liver disease model

“…Compared to FNAC, the risk of complications such as hemorrhage, tumor seeding, infection, fistula formation, bleeding, perforation, and pain can be encountered more in trucut biopsy 11 . Despite its advantages, such as the high sensitivity and specificity rates and reducing the need for other biopsy techniques such as tru-cut, in some types of lesions, FNAC may not provide enough cellular details 13 .…”