Fine Needle Aspiration Cytology With Immediate Assessment

CPT: 88172; 88173
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Test Details

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.

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.

Specimen Requirements

Specimen

Aspirated material

Container

Slides

Patient Preparation

To be determined by attending physician(s)

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.

Causes for Rejection

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

Clinical Information

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.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
009365 Needle Aspiration/Stereotactic 191131 Specimen type: 22633-2
009365 Needle Aspiration/Stereotactic 191153 Source: 22633-2
009365 Needle Aspiration/Stereotactic 191160 Clinician provided ICD9: 52797-8
009365 Needle Aspiration/Stereotactic 191174 Clinician provided ICD10: 52797-8
009365 Needle Aspiration/Stereotactic 191158 ****************************** N/A
009365 Needle Aspiration/Stereotactic 191136 DIAGNOSIS: 22637-3
009365 Needle Aspiration/Stereotactic 191165 Recommendation: 22638-1
009365 Needle Aspiration/Stereotactic 191142 Comment: 22638-1
009365 Needle Aspiration/Stereotactic 191159 ****************************** N/A
009365 Needle Aspiration/Stereotactic 191157 Pathologist provided ICD9: 52797-8
009365 Needle Aspiration/Stereotactic 191175 Pathologist provided ICD10: 52797-8
009365 Needle Aspiration/Stereotactic 191132 Clinical history: 22636-5
009365 Needle Aspiration/Stereotactic 191134 Amended report: N/A
009365 Needle Aspiration/Stereotactic 191135 Addendum: 22639-9
009365 Needle Aspiration/Stereotactic 191150 Diagnosis provided by: N/A
009365 Needle Aspiration/Stereotactic 191137 Signed out by: 19139-5
009365 Needle Aspiration/Stereotactic 191138 Performed by: N/A
009365 Needle Aspiration/Stereotactic 191133 Gross description: 22634-0
009365 Needle Aspiration/Stereotactic 191168 Microscopic description: 22635-7
009365 Needle Aspiration/Stereotactic 191143 Special procedure: N/A
009365 Needle Aspiration/Stereotactic 191179 Previous history: N/A
009365 Needle Aspiration/Stereotactic 191144 QA comment: N/A
009365 Needle Aspiration/Stereotactic 019018 . 11546-9
009365 Needle Aspiration/Stereotactic 000000 NonGyn CPT Code Automation N/A
009365 Needle Aspiration/Stereotactic 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