Needle Aspiration and/or Biopsy

NAME OF PROCEDURE

Needle Aspiration and/or Biopsy

TEST CODE

FNAC

CPT CODE

  • 88172 – Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s)
  • 88173 – Interpretation and report
  • 88305 – Level IV – Surgical pathology, gross and microscopic examination

APPLIES TO

Abdominal Mass Aspiration; Aspiration Without Radiologic Guidance; Bone Needle Aspiration; Brain Needle Aspiration; Breast Cyst Aspiration Cytology; Fine Needle Aspiration Cytology; Joint Needle Aspiration Cytology; Liver Needle Aspiration; Lung Needle Aspiration; Lymph Node Aspiration; Mediastinal Mass Aspiration; Neck Mass Aspiration; Needle Aspiration Biopsy; Needle Aspiration Cytology; Needle Biopsy Cytology; Pancreas Needle Aspiration; Retroperitoneal Mass Aspiration; Synovium Needle Aspiration; Thyroid Needle Aspiration; Transthoracic Lung Aspiration; Wang Needle Aspiration

TEST INCLUDES

  • Fluid: Thin layer preparation, smears, cell block (if indicated).
  •  Tissue: Gross and microscopic examination with diagnosis; cultures may be a useful adjunct.

SPECIMEN

  • Needle aspiration specimen.
  • Volume: Entire specimen.

CONTAINER

  • Solid Material: Specimen container with 10% buffered formalin for solid aspirated material only.
  • Fluid Material: Add specimen to a plastic container containing Cytolyt cytology fixative, rinsing needle with fixative. For large volume aspirations, an equal volume of Cytolyt Solution may be added to specien volume: however, the volume of Cytolyt should be at least 10 ml.
  • Prepared smears, fixed with spray fixative in cardboard slide holders or smears placed immediately in vials of 95% alcohol may also be submitted.  Please label any specimen container(s) with a minimum of two patient identifiers.

COLLECTION TECHNIQUE

See Quick Reference Guide

  • Solid material (core needle biopsy)
    • Aspirated into the syringe then dispensed into a specimen container with 10% buffered formalin.
    • Rinse the barrel of the needle by aspirating formalin into the barrel of the needle and expressing the contents into the specimen container. NOTE: sample may be only in the barrel of needle, not in the syringe.

Please label any specimen container(s) with a minimum of two patient identifiers, time and date collected.

  • Fluid material
    • Aspirated into the syringe and immediately dispensed into a specimen container containing Cytolyt Solution. A minimum of 10 ml of Cytolyt should be used.

If smears are made, fix immediately with spray fixative or immerse immediately into container of 95% alcohol. NOTE: Optimum preservation is obtained if smears are prepared quickly without undue time spent spreading material. Smears should be sprayed or immersed in 95% alcohol with 1-2 seconds after spreading. Spray fixative should be held about 12 inches away. A brief 2 second application of fixative is adequate. Place spray fixed slides in a slide holder prior to transport.

Please label any specimen container(s) with a minimum of two patient identifiers, time and date collected.

If bacteriology is also requested, order the test and submit a separate syringe without fixative. Uncapped or unprotected needles will not be accepted.

Deliver specimens to the Laboratory promptly. Refrigerate specimens that cannot be processed immediately.

REQUEST FORM

  • Solid Material – Complete a Hematopathology Requisition as indicated in the Test Ordering section of this manual. The patient information sections as well as the bottom portion of the form should be completed.
  • Fluid material – Anatomical Pathology Requisition as indicated in the Test Ordering section of this manual. The patient information section as well as the Non-Gyn Cytology portion of the form should be completed.

CAUSES FOR REJECTION

Specimen container or slides not properly labeled.

Improper fixation or drying of the specimen.

LIMITATIONS

A negative diagnosis may reflect improper site of needle insertion and does not completely rule out carcinoma.

Like all cytologic procedures, needle aspiration is subject to sampling error; small lesions may be difficult to sample.

ADDITIONAL INFORMATION

Microbiology studies are not an integral part of this procedure. They must be ordered separately.

Close communication among clinician, radiologist, and pathologist maximizes the usefulness of this procedure.