Needle Aspiration and/or Biopsy
NAME OF PROCEDURE
Needle Aspiration and/or Biopsy
- 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
- 88177 – Immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site
Abdominal Mass, Aspiration Without Radiologic Guidance, Bone, Brain, Breast, Salivary Gland, Cysts, Soft Tissue, Liver, Lung, Lymph Node, Mediastinal, Neck, Pancreas, Retroperitoneal, Synovium, Thyroid, Transthoracic Lung, Pancreas, Needle Aspiration, Needle Aspiration Biopsy, Wang Needle Aspiration, Needle Biopsy Cytology, and miscellaneous Mass Fine Needle Aspirations.
- Information regarding type of specimen, admitting diagnosis, and pertinent clinical history (i.e., age, clinical impression, past diagnosis, radiographic findings, and history of radiation/chemotherapy or malignancy) is essential to interpretation and should be noted on the
- Infectious diseases suspected and special stains requested should be
- Clinical evidence of immunosuppression should be indicated.
- Special handling requirements (isolation) should be clearly noted on the requisition.
- If other studies are required, submit to appropriate laboratory separately.
Aspirated material collected in CytoLyt, smear(s) that are spray-fixed or fixed in 95% alcohol, and/or Diff-Quik smears.
Fine Needle Aspiration (FNA) biopsies are performed to microscopically examine suspicious masses of clinical concern.
- CytoLyt fixative container(s).
- Cardboard slide holder(s) or plastic slide holders.
- Slide containers with 95% alcohol.
- 10% Formalin for solid material (core needle biopsy collected in conjunction with FNA material).
See Quick Reference Guide
- Complete the requisition entirely.
- Pre-label collection container(s) with patient name and sample site.
- Pre-label slides on the frosted-end with patient’s name and sample site.
- Obtain sample using standard FNA techniques.
- If a cyst is encountered during aspiration, evacuate all fluid from the cyst. If there is residual solid area, proceed with FNA using new needle, new syringe, and new CytoLyt container.
- Cyst fluid may be submitted fresh or fixed:
- Submit fresh/unfixed cyst fluid
- Carefully detach needle from the syringe and place a sterile cap on the syringe. Submit with proper labeling.
- To submit fixed cyst fluid:
- Express the evacuated fluid into CytoLyt.
- Aspirate ~ 2 mL of fixative into the syringe, through the needle, to “rinse” the needle and syringe of residual specimen.
NOTE: Any additional cystic fluid from same specimen site may be added to same CytoLyt container.
NOTE: If aspirate from a “new” cystic site is obtained, use a new needle, new syringe, and new CytoLyt container.
- Smears are prepared by using the “pull apart” method.
- Apply 1 – 2 drops of the aspirated material in the center of a labeled slide.
NOTE: Expressing too much material will result in suboptimal preparation; the smear will be excessively thick.
- Place a second slide gently on top of the first slide containing the aspirated material.
- Allow the weight of the slide to spread the aspirated material between the two slides and quickly but gently pull the slides apart.
- Immediately fix one slide by immersing in 95% alcohol or by applying a spray fixative.
NOTE: Optimum preservation is obtained if smears are prepared quickly without undue time spent spreading material.
- Allow the remaining slide to “air-dry” completely.
- Place ~2 mL of CytoLyt fixative into the syringe, through the needle, to “rinse” the needle of residual specimen.
- Repeat steps for each pass from the same site.
NOTE: A fresh needle and syringe should be used for each pass.
NOTE: Each pass from the same lesion/site should be rinsed in the same CytoLyt container.
- Gently place the spray fixed and air dried slides into labeled cardboard slide holder and allow to dry completely before closing and securing for transport.
- Secure cardboard slide holder(s) with tape or rubber bands to prevent opening during transport. Slides maintained at room temperature.
8. If direct smears are not obtained, flush all aspirated material directly into CytoLyt container.
- NOTE: Aspirated material from different FNA sites/sources should never be combined into the same CytoLyt container.
- NOTE: If a “new” FNA site is aspirated, use a new syringe, new needle, and new CytoLyt containers
9. (Seal container(s), syringe(s), and slide holders well to prevent leaking.
10. Place labeled container(s) in a sealable Biohazard specimen bag and include the requisition in the outer pocket of the specimen bag.
11. Send the entire specimen to the laboratory as soon as possible.
**REFRIGERATE ALL CYTOLOGY SPECIMENS IF IMMEDIATE DELIVERY TO LAB/CYTOLOGY IS NOT POSSIBLE**
Anatomical Pathology Requisition
- Complete patient information section.
- Complete the Non-Gynecologic section thoroughly.
CAUSES FOR REJECTION
- Incomplete requisition.
- Specimen container not labeled properly.
- Improperly fixed specimen.
- Gross contamination due to spillage.
- Prolonged period (more than eight (8) hours) at room temperature.
- Delay in delivery for adequate preservation.
- A negative diagnosis may reflect improper side of needle insertion but may not completely rule out carcinoma.
- Needle aspiration procedures are subject to sampling error.
- Small lesions may be difficult to sample.
- Allowing smears to dry before they are fixed will render them unsatisfactory for cytologic
- Smears and thin layer preparations are examined microscopically using the Pap stain method and Giemsa-Wright/Diff Quick stain method.
- Cell block specimens prepared and stained using Hematoxylin & Eosin (H & E) stain method.
- Special stains and special studies (IHC, ISH, molecular, etc.), if needed.
- Close communication among clinician, radiologist/pulmonologist, and pathologist maximized usefulness of this procedure.
- If a lymph node is aspirated, one or two passes should be rinsed into RPMI and submitted for flow cytometry.
- Material for flow cytometry should be collected in RPMI and submitted separately.
- Material collected in formalin (core needle/forceps biopsy) ONLY should be sent to Histology.
Information is also available on the SEPA website under Resources – Directory of Services.
Please call laboratory if you have questions.