Fine needle puncture biopsy

"We have several biopsy techniques to achieve a sample of liver tissue for analysis. Performing a biopsy does not always mean that the patient has cancer".


Fine needle aspiration biopsy or FNA is a diagnostic test that involves the removal of all or part of a tissue sample for examination under a microscope by a pathologist.

Most biopsies are performed with a very fine needle and a syringe that is attached to it to aspirate some cells that will be stained and analyzed. This study is called cytology. It is associated with a low rate of complications due to the small caliber of the needle used.

However, sometimes the cytology is not enough to characterize the alteration and then a larger sample of tissue is needed for analysis. The sample will be fixed, stained and cut for the pathologist to study. This procedure is called histology and requires the use of a thicker needle to obtain more sample.

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When is a biopsy indicated?

During the course of your medical study, some of the imaging tests (X-ray, Ultrasound, CT; MRI,...) may have shown some type of alteration of an unknown nature. In addition, there are inflammatory or infectious processes that, in imaging studies, are indistinguishable from cancer.

In these situations, your physician, even if he considers your problem to be benign, wants to make sure with a tissue sample.

Most frequent indications of this test:

  • Breast cancer
  • Thyroid cancer
  • Breast nodules or cysts
  • Thyroid nodules
  • Liver disorders

Do you have any of these diseases?

A biopsy may be necessary

How is the biopsy performed?

The test is performed on an empty stomach and after having verified that there are no contraindications.

For fine needle puncture (FNA) it is not normally necessary to be in hospital but you must remain at rest for about two hours after the test.

The duration of this procedure varies greatly depending on the procedure and the type of sedation administered. You must remain under observation for some time (up to 4 hours for a lung puncture).

It is tried that the patient does not suffer pain using local anesthetics or low sedation (remains conscious). It is adapted to the type of patient and their situation. The test is normally well tolerated.

Many times the patient does not report discomfort although it is not uncommon to feel a slight pain radiating to the shoulder. In that case, notify the nursing staff to provide a pain reliever.

Computerized imaging techniques (ultrasound and CT) are used to guide us through the procedure. It can be done by any technique but it is decided by one or another according to the type of alteration and previous studies.

When we use CT as a guide, we place the needle in the anomaly in question and confirm it by making a tomographic cut of the area.

When we use ultrasound, we confirm it by visualizing the needle in the lesion on the screen.

The cytopathologist is present during the procedure and will be in charge of making sure that there is enough material for the diagnosis, and if he or she does not consider it sufficient, it will be repeated as many times as deemed necessary.

Only very occasionally and due to multiple causes, the sample may not be diagnostic.

  • You should not take drugs that may predispose you to bleeding (anti-inflammatory, anticoagulants...) You will be asked before the procedure.
  • Let us know if you have any coagulation problems. However, coagulation tests will be performed before the procedure.
  • To reduce the risk of bleeding, you should fast and rest with compression on the puncture site for about four hours after the test is performed.
  • The skin is cleaned with an iodine solution to eradicate the bacteria living on it. Sterile, disposable materials (gloves, sterile needles) are used.
  • The position of the needle is followed by imaging to avoid blood vessels and minimize the risk of bleeding.
  • Bleeding: There is a small risk, which is directly proportional to the size of the needle used, so the risk of bleeding from FAPP is very low (unless there is a coagulation disorder) and this risk is slightly increased when thicker needles are used, but it is still a rare complication. It also depends on the area to be punctured, with liver biopsies being associated with a higher risk of bleeding because of their rich vascularization. In most cases the bleeding is limited and only requires a control of a few hours after the procedure.
  • Pneumothorax (air leakage from the lung): represents a significant risk in lung biopsies. It does not require treatment unless it is large and then hospitalization will be necessary and a drainage tube will be placed to evacuate the air and seal the leak.
    There is a theoretical risk of infection, but it is very rare if sterility measures are met. If the pathology is of infectious origin, the risk is higher.

In case you have persistent pain that does not disappear after standard medication, shortness of breath, weakness, obnubilación, fever or chills should consult the doctor.

Where do we do it?


Anatomic Pathology Service
of the Clínica Universidad de Navarra

We have the most advanced technological facilities and equipment, with our own comprehensive management system.

We collaborate with all the departments of our center and are part of various multidisciplinary areas.

We have great experience in molecular biology, a technique of high sensitivity, specificity and speed. We are specialists in intraoperative studies, necessary for decision-making during surgery, something that requires a high degree of specialization and great coordination with the surgeon.

Organized in specialized sections

  • Image analysis and telepathology.
  • Clinical autopsy.
  • Histotechnology.
  • Immunohistochemistry.
  • Intraoperative study laboratory and macroscopy.
  • Electronic microscopy.
  • Molecular biology techniques.
Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Accredited by the Spanish Society of Pathological Anatomy.
  • Second opinion consultation to corroborate an anatomopathological report.
  • We advise the patient to explain all the doubts he may have.