Cytology, Fine Needle Aspirate


Abbrev Code:FNACT   
Order Code:LAB1001Order Name:Fine Needle Aspiration
Synonyms:Aspiration Biopsy Cytology; Fine Needle Aspirate; Needle Aspiration Cytology; Cytology, Pancreas; FNA, Thyroid; Lymph Node; EUS; EBUS; Lung, Nodule
Methodology:Preparation, staining and microscopic evaluation
CPT Codes: 88173 x1, 88305 x1, 88173-26 x1, 88305-26 x1
Test Includes:Preparation and microscopic evaluation; if special stains or immunoperoxidase stains are indicated they are ordered by the pathologist and performed by laboratory at additional charge. Aspiration by a pathologist will add professional fee. May include on site interpretation by a pathologist if requested.
Turnaround Time:Performed Mon-Fri, 0800-1500; results are reported within 1-3 days. If special stains or immunohistochemical procedures are necessary, additional time may be necessary.
Special Instructions:Provide pertinent clinical history. Also note if special stains for Pneumocystis jiroveii or fungus on lung aspirate are desired. If a liquid sample is obtained, such as from a cyst, see Cytology, Cyst Fluid for preparation instructions. Slides must have two unique identifiers: Full name and date of birth or medical record #. Indicate site if more than one, and indicate air-dried or fixed. For thyroids, indicate nodule size in comment section and site should include left, right or isthmus and inferior, mid, or superior.


Collection Instructions

Specimen:Fine needle aspirate
Container:Thyroid Cancer Panel tube, See Collection Instructions
Collection Instructions:Fine needle aspirates may be treated by either of two methods, depending upon source and type of specimen:
Smear Preparation
  • Ultrasound guided (syringe technique) 
    Two Options:
    • Put entire specimen into formalin. If suspicious for lymphoma, put an additional dedicated pass into RPMI. For thyroids, put a dedicated pass into molecular medium such as Veracyte Afirma.
    • Make slides:
  1. When the specimen is given in a needle, eject 1-2 small drops of aspirated material on two labeled slides (half an inch from the frosted end of the slide) and the rest of the specimen into the molecular medium for thyroids, RPMI if lymphoma is suspected, or formalin for all other specimens.
  2. Place a smearing slide on top of the aspirated material perpendicular to the slide with the material. Do not press down on the slide. Pull the smearing slide to the end of the bottom slide and all the way off to smear the slide.
  3. One slide should be left to be air-dried and labeled "air-dried". The other slide should be fixed immediately in 100% alcohol or spray-fixed until the slide is visibly wet and labeled "fixed".
  4. Repeat for each pass.
 
  • EBUS/EUS guided
  1. Put the entire specimen into a formalin container.
  2. If suspicious for lymphoma, put an additional dedicated pass into RPMI; order Leukemia Lymphoma Evaluation test in Epic and send separately to Flow Cytometry.


Thyroid Fine Needle Aspiration Only:
  • Submission of sample directly into molecular panel preservative: Place patient ID label on molecular panel tube and identify them with nodule. Use separate molecular panel tubes for each nodule. Put all of the material from pass 2 into the molecular panel tube. While slides are being fixed, put any remaining material from the needle into the molecular panel tube.  Discard needle in Sharps container.
  • Submission of sample for Afirma testing: Place patient ID label on the Afirma panel tube and identify them with nodule loculation (left, right, inferior, mid, or superior). Use separate Afirma tubes for each nodule. Put all of the material from pass 2 into the Afirma tube. Discard needle in Sharps container.
  • Submission for cell block: If cell block is needed, put pass 2 into formalin container. While slides are being fixed, put any remaining material from the needle into the formalin container
Causes for Rejection:Syringe with needle attached. No two patient identifiers.


Processing and Shipping

Specimen Processing:Store at room temperature. RPMI store in refrigerator.
Shipping Instructions:Place Afirma tube into empty urine collection container or plastic slide holder first. Slides should be placed in plastic slide holders. Ship specimen along with paperwork in purple refrigerator biohazard bag.
Stability:
  • Fresh unfixed fluid: 24 hours at room temperature; 72 hours refrigerated; frozen is unacceptable.
  • Fixed fluid: 1 week at room temperature or refrigerated; frozen is unacceptable
  • Fixed or unfixed slides: Ambient
Test Performed at or Referral Lab Cytology  (UMMC-East Bank, St. Joseph's)


Interpretive

Reference Range:Results reported as negative to positive for malignant cells or other abnormalities.
Use:Diagnosis of primary or metastatic malignant neoplasms; aid in the diagnosis of infections with fungi; parasites (such as Pneumocystis jiroveii) or some viruses.


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