[Histonet] fine needle aspirates assisting

[Stephen Peters M.D.]

Reviewing the posts I missed while at NSH I thought I could offer a bit on this one. 
At our hospital we have the cytotechs go up first on most FNA's and smear, stain and 
screen the slides. They call us when they get a positive or if the radiologist asks to bring
 a pathologist to check the slides rather than continuing to stick the patient. We then walk
 over and read the slide. This saves us a great deal of time. I will often go from the beginning 
if it is something I know will be difficult like pancreas or lymphoma cases. Our cart has 
H&E and diff quick stains and keeps RPMI and formalin for flow and cell blocks. 
Here are a few things that some of you may find useful.
1) When I make smears rather than put a drop on each slide and smear them, I blow it all 
on one slide and use an additional slide to pick up an aliquot and smear the material to additional slides. This can be done very quickly before things begin clot too much. It also 
gives you a mirror image of the material on the slides so if you are comparing diff quick to 
h&e it will have a similar population. When the material clots it will not smear thin and 
is considerably less readable. Work as fast as you can without sticking yourself.
2) If you get a bloody pass, quickly blow it all out on one slide, 
tilt it up and let the blood run onto a second slide. The specks of tissue will adhere to the 
first slide. Pick the tissue specks a few at a time up using a third slide and smear them 
onto additional slides. These will make very readable blood free slides. Let the puddle of 
blood that you initially ran off clot and use it for cell block. 
3) If I read the final positive slides and I sence that I will need immunos to make a definitive diagnosis, I will tell the radiologist to give me another aggresive bloody pass. We blow it out and let it clot and use this for cell block. Same goes if I think I need flow, I will ask for a pass to put in RPMI. 
4) I continue to ask for passes until I have a good sample or the radiologist gives up. If 
you appear to have less than diagnostic material when you leave radiology, it usually does 
not magically turn positive in your lab. Sometimes the cell block will have something 
that you did not see on the smear but don't count on it. And by good material I mean an
 nice cellular slide. If the radiologist puts a neede into tumor it should yield numerous cells
 and clusters. The exception is very sclerotic lesions such as an old schwannoma where
 you will be lucky to get a few small fragments back.
 
Stephen