Non-diagnostic Needle Biopsy Reports

Whenever physician-clinicians get a needle biopsy report that says “non-diagnostic aspirate” from the pathologists, they usually feel bad thinking that they did not do the procedure properly.  “Non-diagnostic aspirate” usually results from bloody smear or no or very few cells seen.

I always tell the patients the yield of a needle aspiration biopsy reported in literature is about 90%. In my personal experience, the yield is about 95%. Yield means there is information that can be obtained from the needle biopsy.

A “non-diagnostic aspirate” report from a pathologist does not always or automatically mean there is no additional information that one gets from the biopsy that can be used to correlate with the clinical findings.

For example, a 58-year-old female patient whom I suspected to have a 2-cm hematoma mass on the breast. I did a needle biopsy. Grossly, I saw blood and some mucoid substances on the needle aspirate.  I smeared the aspirate and submitted it for biopsy.  The biopsy report came in as “bloody thickly prepared smear, non-diagnostic aspirate.”  After the needle biopsy, my working diagnosis was still hematoma. Patient and I decided to do observation and watch and wait. Two months after, the mass completely disappeared.  My final diagnosis was hematoma.  The aspirate that I submitted to the pathologist really contained only blood because I was dealing with a hematoma of the breast.  The pathologist was looking for breast cells to make a diagnosis of.  However, none was found. Thus, the report of “non-diagnostic aspirate.”

From experience, pathologists also will report “non-diagnostic aspirate” if very few cells are seen, not enough sample to commit to a diagnosis.  There are really instances in which the mass being aspirated will not yield enough cells on the smear.  One situation is the mass is very very small. Another situation is the mass is cystic.  Still another situation is the mass is fibrous or calcified that no or few cells can be obtained.  In such situations, with a pathologist report of “non-diagnostic aspirate,” the clinician who did the aspiration will just have to correlate the microscopic description of whatever few cells are seen with the clinical diagnosis.

This is how I usually manage the “non-diagnostic aspirate” reports of pathologists in the patients in whom I did a needle biopsy.  With my gross needle evaluation and my clinical diagnosis, I manage to extract information from such reports to come out with a working diagnosis.  I don’t just right away submit that I did not do the procedure properly.  I don’t just right away submit there are no additional information that I can get from the biopsy that can be used to correlate with the clinical findings.

ROJ-TPOR@16apr23

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