KUMC Breast Cancer Prevention Center

Fine Needle Aspiration

What is a "Random Periariolar Fine Needle Aspiration (RPFNA)?"
Random periariolar fine needle aspiration (RPFNA) is a procedure that involves removing cells from the breast with a very narrow needle and analyzing them for changes in appearance and molecular makeup. This procedure was designed to determine if we could predict short-term risk for breast cancer among women already at high risk for the disease.

What happens during the procedure?

First, we numb the skin in two areas of the breast with Lidocaine, a local anesthetic similar to what is used at the dentist’s office. We will then insert a needle in the breast through the anesthetized area, and apply mild suction to remove the breast duct cells. This may sound painful, but there is very little feeling in most women’s breasts after the skin is anesthetized. (The average discomfort score is 1 on a 0-10 scale). We do offer a prescription for Ativan (an anti-anxiety medicine) to all women for use prior to the procedure. However, most patients find it unnecessary. If you choose to use Ativan, make sure to bring someone with you to drive home. If you are pre-menopausal, the mammogram and breast exam must be done between days 1-10 of your menstral cycle.

How much does fine needle aspiration cost?
Nothing! The cost of fine needle aspiration is covered by grants. There is no direct cost to you. You will not be required to pay for blood work associated with the aspiration, or the aspiration and analysis of cells. However, you (or your insurance) will be expected to pay for an annual mammogram and other clinical services provided to you in the prevention center other than the aspiration. You (or your insurance) will have to pay for any sonograms/compression views that are sometimes recommended as follow-up to an abnormal mammogram. If you require any blood test that is not associated with a clinical trial, you (or your insurance) will be responsible for this cost. Rarely, a diagnostic biopsy is recommended to assess a worrisome lump that is found on the mammogram a patient has the day she comes in for random fine needle aspiration. If we have to perform this procedure and you agree, you (or your insurance) are responsible for the cost of this procedure. We will not perform a RPFNA the same day a diagnostic biopsy is performed.

Please remember that the RPFNA visits are very expensive for us (~ $2,000 per visit). We will not be able to perform a scheduled RPFNA if:

You start or stop your hormones within six months prior to your aspiration

Start evista or tamoxifen

Are in the wrong part of your menstrual cycle (day 11-28)

How does RPFNA better determine my risk?
We determined in a prospective trial of approximately 500 women followed for an average of 4 years that finding atypical cells increased their risk five fold over the next five years compared to those without atypia. RPFNA results are helpful in increasing the short-term accuracy of epidemiologic models such as the GAIL model.This information has been published in the August 2, 2000 issue of The Journal of the National Cancer Institute.

We are currently validating our initial results with a second set of women. We are also assessing other risk biomarkers along with cell appearance including cell proliferation and mammographic density.

What happens after aspiration?
If your results suggest atypia, we may recommend a clinical breast exam by an experienced breast clinician twice a year, and perhaps a combination of mammography and breast sonography. (imaging every six-months) Breast MRI is generally only covered by insurance in specific situations (i.e. women who are carriers of a BRCA 1/2 mutation). In addition, you may want to consider standard prevention therapy such as tamoxifen . As a result of the aspiration findings, you may be eligible to participate in one of our prevention clinical trials. If this is the case, one of our research staff will talk with you about current trials, and you can decide if one is right for you.

If your results are normal, we generally recommend annual mammography and clinical breast examination and less frequent (every 2-3 years) fine needle aspirations. We do not generally perform RPFNA in women over 60. If this is your first FNA, we generally repeat the procedure in 12 months.

How do I get my results?
It usually requires 3-6 weeks to get final results from the lab as well as the pathologist reading. If there are enough cells, we will preform a test for both cell appearance and growth rate. At that time, Drs. Fabian, Kahn and Sharma discuss the results with staff while reviewing your personal and family history, and recommend appropriate follow-up care. You will be called or e-mailed (with your consent) to initially inform you of your results, and then we will mail you a letter that details the results and recommendations.

Who is eligible for random fine needle aspiration?
Women with any of the following conditions are potentially eligible:

First-degree relative (mother, daughter or sister) who had breast cancer diagnosed at an age younger than 60

Prior diagnosis of atypical hyperplasia or carcinoma in situ (cancer still contained within the ducts or lobules of the breast) determined by a breast biopsy

Previous node-negative breast cancer

Multiple second-degree relatives who had breast cancer, with at least one of the relatives being younger than 50 at diagnosis

Multiple biopsies or high breast density (> 50%)

Conditions for ineligibility:

Taking chemotherapy or chemopreventive medicine of any kind, including tamoxifen (Nolvadex), raloxifene (Evista), letrozole (Femara) or anastrozole (Arimidex) for a year or more

Breast implants

The use of blood-thinning medicine (Coumadin, heparin, Plavix, Lovenox)

What do I need to do before an aspiration?

Three weeks prior to your appointment, you must discontinue any medication that impairs blood clotting, specifically aspirin and ibuprofen (Advil, Motrin). We also ask that you stop fish oil, vitamin E and all herbal supplements, especially gingko biloba, echinacea, and ginseng. We will ask you about all medicines you take when you make your appointment.

You must have a current mammogram performed within three months of the RPFNA. If you are pre-menopausal the mammogram must performed between day 1-10 of your menstrual cycle. (Day 1 is the first day of bleeding).

What if I am on hormones?

Women on hormone replacement therapy can undergo an RPFNA. Our protocol does allow us to perform RPFNA on women who have stopped, started or made a major change in their hormones within the last six months.

I am pre-menopausal: Does it matter what part of the menstrual cycle the aspiration is performed in?

YES! The RPFNA and mammogram must be done sometime between day 1-10 of the menstrual cycle (day 1 is the first day of bleeding) to decrease discomfort and avoid false positive results.