Needle aspiration biopsy: role and limitations in surgical decision making

A total of 464 fine-needle aspiration biopsy specimens in 450 patients was studied. The majority of these aspirates were performed by the pathologist. The technic was 95% sensitive, 99.5% specific, and 97.0% accurate when correlated with histopathology or long-term follow-up. The complication rate was 0.9% and occurred only when needles larger than #22 were used to aspirate lung lesions resulting in pneumothorax. A flow chart for the role of needle biopsy in investigating masses of various organs is presented, together with some illustrative examples. In the current atmosphere of cost-containment, this inexpensive yet fast and accurate technic should play an important role in surgical decision making. However, pathologists and clinicians should be aware of the limitations and should not hesitate in obtaining an open biopsy when necessary, particularly when clinical suspicion for malignancy is not confirmed by the aspiration, in view of the small but significant (4.9%) false-negative rate.