For people who believe that they have head, neck, or breast cancer, a biopsy is the only definitive way to tell if a lump is cancerous or benign. It’s one of the first steps in the diagnosis process, and you can choose to have ultrasound-guided fine needle aspiration (FNA) or an incisional biopsy.

Most people choose a reputable FNA specialist and go this route for a variety of reasons. We’ll compare ultrasound-guided FNA and incisional biopsies to give you a good idea on what you should expect, and it can also help you understand why the majority of people choose FNA.

Defining Ultrasound-Guided Fine Needle Aspiration

This is a routine procedure to check lumps in your breasts for cancerous cells. This outpatient procedure uses ultrasound waves to pinpoint the location of your lump. Once they know exactly where it is, they’ll insert a fine needle and use the ultrasound machine to guide it to your lump. Your physician will then get a small tissue sample using the fine needle and analyze it for cancerous cells.

This is an outpatient procedure that has no downtime. You’re able to return to your daily activities immediately without any issues. You won’t have a scar to worry about with this procedure either, and you won’t get exposed to ionizing radiation like you would with other forms of breast biopsies.

Common Reasons to Have an Ultrasound-Guided Breast Biopsy

•    Finding a suspicious lump

•    Abnormal tissue changes

•    Breast tissue structure distortion

Defining an Incisional Biopsy

On the other hand, you have an incisional biopsy. While this is also a routine procedure, it’s more invasive. Your physician will locate your lump using either ultrasound or x-rays, and then they’ll make an incision close to it. They’ll go in and remove part your lump and test the tissue for cancerous cells.

This type of biopsy requires more care on your part because you’ll want to watch and clean your incision regularly to prevent infection. You may have a few hours or a few days where the area is sore, and it usually leaves a small scar where the original incision was made.

Common Reasons to Have an Incisional Biopsy

•    The lump is closer to the surface

•    There is more than one lump close together

•    You need to obtain more tissue

Understanding the Difference Between FNA and an Incisional Biopsy

There are several differences between these two types of biopsies, and it’s easy to see why more people choose FNA over an incisional biopsy when you start to compare them side by side.

•    Downtime – After you complete your FNA procedure, you’re free to go home or go about your daily activities relatively pain-free. You may feel more pain if you choose to have an incisional biopsy because there is more trauma to the tissue.

•    Infection – The last thing you want is to get an infection, and FNA can reduce your chances of developing one because there isn’t a large open area at the end of the procedure. You’ll have a small open wound with any incisional biopsy procedure.

•    Scarring – A FNA procedure doesn’t leave a scar when it heals. It’s a fine hollow needle that collects the sample. With incisional biopsies, your physician makes a small incision that can leave a scar when it heals.

Ultrasound-Guided FNA of the Breast Procedure

When you go in to see your FNA doctor and have your procedure, there usually isn’t a large preparation process or anything special that you have to do before you have it. You do want to wear a comfortable two-piece outfit, and you may consider bringing a family member or friend with for support.

Once you arrive for your appointment, your FNA doctor will have you change into a gown. You’ll go into the ultrasound examination room and lay flat on your back. They’ll ask you to put your arm above your head in a comfortable position on a pillow. When you’re in this position, your doctor will apply a clear gel to the area where they want to perform the FNA.

They’ll use the ultrasound machine and slowly move it across your breast to get a clear picture of your lump. Once they have a clear picture, they’ll clean up the area and apply a local anesthetic. This will numb the area before they introduce the needle. They’ll insert the needle and use the ultrasound machine to guide it toward your lump.

Once the needle gets to your lump, your doctor will start to apply two or three gentle backward and forward movements with the needle. These are typically less than one centimeter, and it’s how your doctor is able to get a tissue sample from the lump and the surrounding area.

They’ll withdraw the needle and apply some antiseptic cream along with a band-aid to keep the area clean. Then, they’ll analyze these samples to look for cancerous cells under a microscope.

You’ll be free to leave and go about your normal routine once the procedure is over. You do want to avoid participating in strenuous activity for at least 24 hours, and you may notice some minor tenderness or swelling at the biopsy site. Temporary bruising is also a normal side effect of this type of biopsy, and you can manage your pain with over the counter pain medications.

Benefits of Ultrasound-Guided FNA

•    Minimally invasive with minor trauma

•    Reliable method to test for cancerous cells

•    Very little downtime

•    Ultrasound allows your doctor to accurately get a tissue sample from your lump

•    From start to finish, typically takes around an hour

•    Can be less expensive than other biopsy types

•    Minimal to no scarring

•    Reduced risk of infection post-biopsy


If you have a lump in your breast, and you’re considering having a biopsy, fine needle aspiration is something you want to consider. As long as you go to an FNA specialist, you should have a quick procedure with very little interruption to your daily activities.

Schedule Appointment

Celina Nadelman, M.D.

1125 S. Beverly Drive #602
Los Angeles, CA 90035
Call us: 310.702.6701