Fine Needle Aspiration Cytology

CPT: 88173
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Test Details

Synonyms

  • Breast
  • Breast Cyst Fluids
  • Lymph Nodes
  • Salivary Gland
  • Thyroid
  • Thyroid Cysts

Test Includes

Cytologic evaluation of specimens obtained by fine needle aspiration from lesions of all body sites

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, thin preps, and/or cytospins will be made along with a cell block, if applicable. Microscopic examination is performed.

Specimen Requirements

Specimen

Aspirated material

Container

Slide(s), Coplin jar(s)

Collection

Use a small gauge (eg, 25-g or 22-g) needle to avoid dilution with blood. Immobilize the palpable mass with your nondominant hand. Using a syringe holder will allow you to keep your nondominant hand on the mass. Insert the needle into the mass and pull back on the syringe plunger, creating negative pressure, using it as a cutting tool. Make short 5 mm “in-and-out” motions until you see material coming into the hub of the needle. When you start to see material in the hub, stop, release negative pressure on the syringe, and pull out to make the slides. Do not aspirate material into the syringe or dilute with blood or saline. This interferes with making good direct smears. (See preparation of slides below.) If you do not see any material at all in the hub or syringe, continue the short 5 mm strokes until you have done 15 to 20 strokes. Pull out and attempt to express material on slides (see below). Repeat the above procedure again using a clean needle for a second pass (and more passes if needed). Many physicians use no local anesthesia. If you decide to give a local, please avoid aspirating the local anesthetic into the needle. It will dilute as well as distort the specimen.

Making direct smears (preferred method):

• Using a graphite pencil, label 8 to 10 slides with the patient's name before starting the procedure.

• After aspiration, make sure to have positive pressure in the syringe (if need be, remove the needle, pull back the plunger, then reattach the needle to gain positive pressure). Avoid aspirating the material from the needle into the syringe.

• Touch the end of the needle to the end of the glass slide and express one to two drops of material. (If too much material is expressed, the slides will be too thick for optimal interpretation. A thin monolayer of cells is desired.)

• Place a second slide on top of the first, allowing the drop to spread, then gently pull slides apart toward opposite end. Fix immediately in 95% ethyl alcohol. Note: It is imperative to fix the slides immediately to avoid air drying. Continue making more slides in this fashion until all the material in the needle is used.

• Do not discard the needle yet. Rinse the needle in a labeled container of balanced salt solution and an equal volume of 50% ethanol. Send all material to the lab.

Alternative to making direct smears (less desirable, but acceptable): Express the specimen directly into a balanced salt solution and an equal volume of either 50% ethyl alcohol or Saccomanno fixative. Send to the laboratory for slide preparation.

If a cyst is aspirated, use the alternative method outlined above. The laboratory will spin the specimen for concentration.

Storage Instructions

Refrigerate

Causes for Rejection

Improper labeling; improper fixation; air-drying artifact; specimen submitted in vial that expired according to manufacturer's label

Clinical Information

Special Instructions

Include patient's name, date of birth, Social Security number, source, previous malignancy, drug therapy, radiation therapy, and all other pertinent clinical information on the test request form.

It is recommended to do an aspirate only on a palpable mass. (“Blind” sticks are discouraged except for those under radiologic guidance.) A minimum of two separate passes should be done, preferably more (inadequate specimens result in false-negative diagnosis).

It is very important to specify the source of the specimen along with clinical history and clinical impression. If a cyst is aspirated, indicate this fact on the test request form; it will most likely be hypocellular but will not be a false-negative. If the patient has a known diagnosis of malignancy, please include that information on the test request form. Whatever the specimen source, please include your clinical impression and reason for doing the aspiration (eg, “fine-needle aspiration on lymph node: suspect lymphoma vs metastatic carcinoma vs infectious process”).

If an infectious process is in the differential, please submit a portion of the specimen to microbiology in an appropriate sterile medium or transport container. Once the specimen is smeared and/or put in an alcohol container, it is unsuitable for culture.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
009001 Fine-Needle Aspiration 191131 Specimen type: 22633-2
009001 Fine-Needle Aspiration 191153 Source: 22633-2
009001 Fine-Needle Aspiration 191160 Clinician provided ICD9: 52797-8
009001 Fine-Needle Aspiration 191174 Clinician provided ICD10: 52797-8
009001 Fine-Needle Aspiration 191158 ****************************** N/A
009001 Fine-Needle Aspiration 191136 DIAGNOSIS: 22637-3
009001 Fine-Needle Aspiration 191165 Recommendation: 22638-1
009001 Fine-Needle Aspiration 191142 Comment: 22638-1
009001 Fine-Needle Aspiration 191159 ****************************** N/A
009001 Fine-Needle Aspiration 191157 Pathologist provided ICD9: 52797-8
009001 Fine-Needle Aspiration 191175 Pathologist provided ICD10: 52797-8
009001 Fine-Needle Aspiration 191132 Clinical history: 22636-5
009001 Fine-Needle Aspiration 191134 Amended report: N/A
009001 Fine-Needle Aspiration 191135 Addendum: 22639-9
009001 Fine-Needle Aspiration 191150 Diagnosis provided by: N/A
009001 Fine-Needle Aspiration 191137 Signed out by: 19139-5
009001 Fine-Needle Aspiration 191138 Performed by: N/A
009001 Fine-Needle Aspiration 191133 Gross description: 22634-0
009001 Fine-Needle Aspiration 191168 Microscopic description: 22635-7
009001 Fine-Needle Aspiration 191143 Special procedure: N/A
009001 Fine-Needle Aspiration 191179 Previous history: N/A
009001 Fine-Needle Aspiration 191144 QA comment: N/A
009001 Fine-Needle Aspiration 019018 . 11546-9
009001 Fine-Needle Aspiration 000000 NonGyn CPT Code Automation N/A
009001 Fine-Needle Aspiration 191167 Photomicrograph N/A

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf