Fine Needle Aspiration of a Palpable Breast Mass Instructional Video

hi my name is dr. bread corn I'm a family physician and today I'm going to be demonstrating to you how to do a fine needle aspiration of a palpable breast mass when a patient presents to your

office and concerned about a lesion in her breast and you can actually feel a breast mass it's worthwhile right then and there in the office to try to aspirate it it's recommended in fact

that all family physicians and nurse practitioners do this because if the cyst is able to reduce immediately and disappear you can actually a reassure the patient that there's nothing

worrisome going along and be probably decrease a lot of anxiety that this patient is going to have if however the there's still something palpable or you don't get much in the way of fluid

coming out then you're going to need to move forward with two more steps ordering a mammogram and referring the person to a surgeon or another person

who's comfortable assessing the lesion so why don't we get started and I'll show you on our model the best way of going forward with this procedure now

for our model today what we're going to be using is a is a ziploc bag filled with flour and our masses are actually cherry tomatoes so the procedure is

something that's really straightforward that you can do in your office and as I said I tend to do it when the patient is presenting as opposed to bringing them back for a special episode because you can just do it in the office now let's

talk about the equipment it's actually pretty straightforward but you're going to need a pair of gloves and you're going to need a sterile syringe I would recommend a 10cc syringe which tends to work the best and a needle you can use

anywhere from a 22-gauge to a 25k each needle either an inch to an inch and a half long for today's demonstration we're going to be using a 25 gauge one inch long needle somebody for cleansing

the skin povidone and/or alcohol I always have some gauze now normally I use just a dot band-aid the same type of band-aids that we use after immunizations but sometimes if the wound

is oozing because you've gotten a superficial blood vessel I'll create a pressure bandage with a little bit of gauze and a bigger band aid on top so we perform before you perform the procedure

you should review possible complications with the patient these include the potential for infection the potential for a small amount of bleeding and the theoretical complication of a pneumothorax which

again is a is a theoretical complication and I'll show you a technique that can reduce that uncommon complication to very rare now one thing to keep in mind is this procedure should not be

performed in two cases if the patients had a past history of breast cancer or if the mass is really quite deep and then difficult to palpate so those would

be the contraindications now I don't use local anesthetic sometimes patient of you we're going to be using a small needle and so it's very well tolerated sometimes patients are quite nervous and

so if you want you can use a tubercular and syringe with a small amount of lidocaine or you have the option of prescribing some emla cream applying it but then the patient I bigger the prescription filled you'd have to wait

an hour for that to take effect so that could slow things down but anyway let's move on to the procedure now what you need to do obviously is wash your hands

put your gloves on and what I do is I Prime the syringe a couple of times to make sure that the the plunger moves easily so you have your syringe product

as I said before I've already got my my cleaning solution and my band-aid ready to go taking your non-dominant hand you

palpate the breast and you isolate the mass between your thumb and your first finger and you want to hold that fairly

firmly then taking your cleaning solution in a circular motion clean the skin taking the cap off of your needle

holding it like a pencil you then insert directly into the lesion you can go directly in or you can go sideways either way is appropriate how I

recommend that you don't let go over the mass with your non-dominant hand once you have the needle in place and what we're going to be doing is once the needle is in place is then moving my a

thumb up to pull the syringe up and I'll show you once we get in so i'm holding the mass firmly skin has been cleansed you enter in until you feel it enter

into the lesion moving my thumb up I then create a suction and if this was a

cyst we would see the syringe filled with fluid often the fluid is a grayish green color and depending on the size of

the cyst you may fill the syringe up now once this or once you feel that you've gotten all the fluid out you can milk the mass to make sure that it is

completely emptied their pullback creating suction holding the needle steady and then when that's done you release the mass with your non-dominant

hand pull the needle out putting that aside you can then apply guys if you wish or your band-aid now that the procedure is over there's a couple more

steps that you need to be aware of first of all when you have fluid in your syringe from the aspirin you do not need to send that for any kind of pathological assessment all you need to do is just discard it even if it has

blood in it then the next thing you do is you need to palpate the breast so one or two options when you palpate you may not find any mass left at all it is

completely disappeared you can a reassure the patient that this was definitely assist and be have them come back in about four to six weeks you could re-examine to make sure that there's nothing there now if on the

other hand you do palpate and there is still a mass there something that you can feel you have a couple of steps you have to follow first of all you'll need to send if the patients over the age of

35 for amibroker if you're under the age of 35 it's recommended you send them for an ultrasound you also need to set up at the same time an appointment with a

either of surgeon or radiologist who's comfortable doing a biopsy even if the mammogram comes back normal you still have to take the second step of making a referral because sometimes mammograms

can be misleading so this procedure is a very simple straightforward procedure that you can do in your office you don't have to send out samples to pathology of

any kind and you have the option of reassuring a patient right away they're in your office that everything is fine eat it at the four to six-week follow-up is unlikely that you're going to help it

anything more if the cyst this appears initially thank you very much you