Fine Needle Aspiration Clinic Research Articles

Building a smart FNA cart: When Google meets cytology.

The appropriate management of a fine needle aspiration (FNA) supply cart and equipment set up is essential to ensure the smooth and optimal operation of a busy FNA clinic. We applied Lean strategies such as value stream mapping (VSM), the 5S method (Sort, Set in order, Shine, Standardize, Sustain), and Kanban to remove waste and improve patient flow in an FNA clinic. The workflow analysis suggested that existent problems such as suboptimal inventory management and unavailability of standard operating procedures (SOPs) caused a 10% to 85% increase in total procedure time. To improve inventory management, we created a 2-bin Kanban system. We used the "Scan to Web" app and a Google Drive form to create a cost-effective electronic inventory management system. We distributed the essential SOPs in the format of video clips using our YouTube channel and leveraged barcode technology to access the links. Upon completion of our process improvement project, we succeeded to eliminate the stock-out events and maintain a process cycle efficiency of 87%. The 5S audit checklist result increased from 6% to 100% implementation, which is consistent with focused improvement. The developed inventory system enabled us to track the supply usage, forecast demands, and improve the accuracy of orders. Lean methods such as VSM, 5S, and Kanban combined with open source technologies can be implemented to ensure material availability, track inventory, and provide immediate access to SOPs on demand. The developed system also led to increased efficiency and improved flow, as well as responsiveness to changes in demand.

Young Investigator Challenge: Building an ultrasound‐guided FNA clinic—our 5‐year experience: From project to practice

The authors' fine-needle aspiration (FNA) clinic opened in 2010, allowing cytopathologists to increase their proficiency and experience in FNA performance. Here, they report their 5-year experience. The FNA clinic log book and the institution's database were retrospectively reviewed to record patients' demographics, the number of FNAs performed per year by each cytopathologist, the number of passes, rapid on-site evaluation (ROSE) and diagnosis, adequacy-diagnosis concordance, and follow-up histology when available. The numbers and types of cases per year and variations among cytopathologists were compared. In total, 474 cases were identified within a 5-year time-frame. The discrepancy rate between the on-site and final diagnoses decreased progressively, from 4.4% to 2.4%. The nondiagnostic rate decreased from 2011 to 2015, with the exception of 2014, when an increase was noted, possibly because of a lower number of cases. Cytopathologists' performance was assessed over a 3-year period. The number of passes for each FNA decreased over time. The cytology-histology concordance was 100% over time for all cytopathologists. There was a diagnostic discrepancy between the ROSE and final diagnoses for 3 of 104 cases in 2013 and for 3 of 124 cases in 2015. The total number of passes was not consistently recorded until 2014, when a final report template was instituted. The technique improved over time because of accumulated experience, constant practice with phantoms, and attending the College of American Pathologists' training in ultrasound-guided FNA. FNAs performed by cytopathologists have a high-rate of ROSE/adequacy and a low diagnostic discrepancy rate. Cytopathologists as interventionalists provide optimal care and excellent patient satisfaction. Cancer Cytopathol 2017;125:161-168. © 2016 American Cancer Society.

Talking to patients about a diagnosis of malignancy in a fine‐needle aspiration clinic setting

Talking to patients about a diagnosis of malignancy in a fine‐needle aspiration clinic setting

Fine‐needle aspiration of a pleomorphic lipoma of the head and neck: A case report

Pleomorphic lipoma is a rare soft-tissue tumor, most commonly seen in the head and neck regions of middle-aged men. Fine-needle aspiration (FNA) of these lesions can present a diagnostic challenge. Its large, hyperchromatic cells and multinucleated forms (floret cells) can easily be mistaken for a malignancy. A patient with a round, well-circumscribed, painless, soft, subcutaneous posterior neck mass for 6 yr presented to our FNA clinic. Aspiration of the mass showed a hypocellular specimen with atypical large and floret cells with fragments of mature fibroadipose tissue in the background. Based on the clinical and cytomorphological findings, a diagnosis of pleomorphic lipoma was suggested, and it was confirmed on excision. This case highlights the need to be aware of unusual benign lesions that may arise in the head and neck region. Knowledge of these benign lesions will help in making the correct cytological diagnosis when these lesions are sampled by FNA.

Fine Needle Aspiration in the Management of Thyroid Nodules: Experience at King Khalid National Guard Hospital, Jeddah

Fine Needle Aspiration in the Management of Thyroid Nodules: Experience at King Khalid National Guard Hospital, Jeddah

Fine-needle aspiration in the management of peripheral lymphadenopathy in a developing country.

Fine-needle aspiration (FNA) is a simple, cheap, and well-tolerated procedure that is well-established as a method of definitive diagnosis of palpable masses. This review reports the role of FNA in the investigation of peripheral lymphadenopathy as an alternative to expensive surgical excision biopsy in developing countries, where there are limited funds and facilities. All lymph node aspirates done in the FNA clinic at the Department of Pathology, University College Hospital, Ibadan, between 1995-1997 were reviewed. The aspirates were obtained using 21- or 22-gauge needle with a 5- or 10-ml disposable plastic syringe, smeared on standard microscopic slides and stained with Giemsa and/or Papanicolou stains. The most common diagnosis was reactive change/nonspecific inflammation, constituting 33.4%; tuberculosis and metastatic lesions made up 25. 7% and 22.4%, respectively, while lymphoma constituted 16.9% of cases. The commonly aspirated nodes were cervical. Tuberculosis was the most frequent diagnosis in these nodes and was the most commonly diagnosed infective condition, particularly in those under age 20 years. The sensitivity and specificity of lymph node FNA in the diagnosis of tuberculosis were 79.5% and 100%, respectively. The overall accuracy rate of lymph node aspiration was 89.5%. Our study showed that FNA is a simple, cost-effective procedure which offers a reliable method of diagnosis in distinguishing reactive lymphadenopathy, tuberculosis, and malignant conditions. Diagn. Cytopathol. 1999;21:159-162.

Utility of punch biopsy for lesions that are hard to aspirate by conventional fine-needle aspiration.

Fine-needle aspiration (FNA) is a fast, reliable, and cost-efficient technique for diagnosing palpable masses. However, when the lesion is small, dermal in location, shallow in depth, or fibrotic, the cellular yield by FNA may be limited and thus hinder an accurate diagnosis. The authors examined the value of punch biopsy (PB) in diagnosing such hard-to-aspirate lesions. The authors reviewed 49 PB specimens from 47 patients who presented in their FNA clinic from June 1994 to July 1997. The lesions were typically described as ill-defined erythematous skin lesions or as papules or small, firm, subcutaneous nodules (average size, 0.7 cm). Patients' previous history included breast carcinoma (in 36 cases), nonmammary carcinoma (in 3 cases), melanoma (in 2 cases), squamous carcinoma of the skin (in 2 cases), cutaneous T-cell lymphoma (in 2 cases), small lymphocytic lymphoma (in 1 case), and no history of malignancy (in 1 case). PB sites included chest wall, breast, extremities, abdominal wall, neck, back, scalp, and forehead. Of the 37 cases in which FNA was performed before PB, 21 aspirates (57%) were nondiagnostic because of scant cellularity, 11 aspirates (31%) were positive (9) or suspicious/atypical (2) for malignancy, and 5 aspirates (14%) were negative for malignancy. Seventeen (81%) of the 21 nondiagnostic aspirates and 10 of the 11 suspicious/atypical aspirates were positive for malignancy on PB specimens. Twelve PBs were done without prior FNA, 8 (67%) were positive for malignancy, and 4 (33%) were negative. In 7 patients, the findings from the PB specimens (new diagnosis of malignancy in 5 cases and recurrence of disease in 2 cases) led to surgical excision of the lesion. PB is a valuable adjunct to FNA for diagnosing hard-to-aspirate lesions.

Fine needle aspiration (FNA) cytology of the breast: the influence of unsatisfactory samples on patient management.

FNA continues to play an important role in the management of patients with breast lesions. However, the reliability and efficiency of the FNA service depends heavily on the quality of the specimens. We have audited the rate of "inadequate FNAs' at intervals over the last 5 years and related our findings to the clinical expertise of the aspirator. We have also correlated the rate of inadequate FNAs with the percentage of patients who had an FNA preceding a definitive diagnosis of cancer. We report trends in the rate of inadequate samples, and subsequent diagnosis of cancer, over a 5-year period. The percentage of breast FNA samples reported as inadequate was 46.8% in 1988-89, falling to 20% in 1991-92 with the introduction of an FNA clinic, and rising to 30.6% in 1993. The rates of cancer following inadequate FNA were 15.7%, 16.1% and 4.2%, respectively, and the percentage of patients with cancer having a preceding inadequate FNA were 37.5%, 13.2% and 7.1%. Possible explanations for the apparent paradox between increasing numbers of inadequate FNA specimens and a falling breast cancer rate are discussed.

Cost Effectiveness of A Fine Needle Aspiration Clinic

The resource implications of a Fine Needle Aspiration (FNA) Clinic at Northampton General Hospital have been evaluated over a 12 month period using a patient management questionnaire. A total of 490 cases from which fine needle aspirates were taken from superficial sites have been assessed (breast 381, thyroid 46, lymph node 44, salivary gland 9, soft tissue 10). Total resource savings (135,544 pounds) exceeded the expenses of the FNA clinic (27,290 pounds). Potential cost savings per case were the greatest for thyroid aspirates. The FNA clinic where the pathologist takes, stains and reports optimally prepared specimens, provides a high quality and accurate service on which clinicians can confidently base clinical management decisions. Unnecessary investigations and operations are avoided, allowing scant resources to be released for other procedures.