Fine Needle Aspiration Cytology With Immediate Assessment

Fine Needle Aspiration Cytology With Immediate Assessment

Number
	009365
CPT
	88172; 88173
Synonyms
	Adrenals ; Breast ; Liver ; Lung ; Lymph Node ; Pancreas ; Salivary Gland ; Soft Tissues ; Thyroid
Test Includes
	Rapid Pap stain or Diff-Quick® on collected specimen for evaluation of adequacy of specimen. Determination of adequacy is done while the patient is undergoing the procedure. Allows clinician/radiologist to determine accuracy of sampling as well as determining if continued samplings are necessary.
Special Instructions
	Include patient's name, date of birth, sex, Social Security number, previous malignancy, drug therapy, radiation therapy, and all other pertinent clinical information, including history of alcohol abuse, on the request form. Laboratory personnel must be present for needle aspiration procedures under radiologic guidance if rendering of initial interpretation of quality of the specimen is desired. Call the cytology department manager for time arrangement. Twenty-four hour notification is preferred. Specify body site. Include pertinent clinical data on the request form (ie, age, history of carcinoma or infection, history of smoking, exposure to carcinogenic agents). A minimum of two samplings of the site is suggested.
Specimen
	Aspirated material
Container
	Slides
Collection
	Smears will be prepared by the cytotechnologist when present. Radiologist collects specimen. If technologist is not present follow this procedure for preparing slides. Fill Pap jar with 95% ethyl alcohol Using a graphite pencil, label slides with patient's last name and first initial. Localize mass. Disinfect area. Apply local anesthesia on/in area to be needled. Introduce needle into mass. Create negative pressure and maintain. Sample area vigorously on several planes, maintaining the negative pressure. Note: Sample may be only in barrel of needle not in syringe. If no specimen is seen in syringe it does not mean an adequate sample has not been obtained! Release the plunger of the syringe to equalize pressure. Withdraw the needle from the mass. Place bevel of needle directly on one of the glass slides (in approximately the center of the slide). Express one to two drops of material onto this glass slide. Visible material expressed? Place the other glass slide on top of the first, and gently pull the slides apart - dispensing the material on the slides evenly. Important!! Place the slides back to back, in the jar of fixative immediately! No material expressed? Make a second attempt to express material on slide by first removing the needle from syringe. Pull back on syringe plunger, then place needle back onto syringe. Express one to two drops of material on the slide. If no material is expressed on the slide, rinse the barrel of the needle by aspirating saline into the barrel of the needle by aspirating saline into the syringe and expressing the saline wash into a clean container. Add an equal volume of Saccomanno fixative to this fluid. Attach the request form and transport the specimen to the laboratory.
Storage Instructions
	Slides in 95% ethyl alcohol will maintain well at room temperature. Saline wash of needle with Saccomanno fixative added in equal volume will maintain well at room temperature. Saline wash without fixative must be refrigerated and transported to cytology as soon as possible.
Patient Preparation
	To be determined by attending physician(s)
Causes for Rejection
	Improper labeling; improper fixation; air-drying artifact; specimen was submitted in a vial that expired according to the manufacturer's label
Use
	Diagnose primary or metastatic malignant neoplasms; differential diagnosis of benign versus malignant processes
Methodology
	The fluid will be centrifuged, supernatant poured off, and diagnostic cells aspirated from the remaining material. Filters, monolayers, and/or cytospins will be made along with a cell block, if applicable. Microscopic examination is performed.