[Histonet] FNA'S

[Stephen Peters M.D.]

Few tips that have worked for me. On our FNA carts we keep a simple H&E set up 
  as we would in the frozen room,and a diff quick set up. I find a very key factor is
   to quickly make the smears before it begins to clot. I find my besy chance of this 
  is to immediately express all the material on one slide ( if it fits) and the quickly
   devide it by touching the puddle with one or more additional slides, quickly 
  smearing it and getting it right ino 95% ETOH or air drying. When you get very bloody passes quickly tilt up the slide, run the blood  off and pick up the small 
  remaining pieces and smear them on a other slide.This will give you blood 
  free smears.  Let the blood clot and put it in formalin for a cell block.  Hope fully 
  you have a pathologist that will come down for a quick assessment.You should 
  also have RPMI for flow cytometry and ask for another pass if lymphoma is suspected. Keep some small formalin bottles and tissue or filter bags to wrap 
  small fragments or cores that you will sometimes get which are suitable for 
  histology. When I see the initial sample and suspect I will need immunos to make 
  a diagnosis or suggest a primary site for a met to the liver for example, I ask for a 
  core biopsy or an aggressive bloody pass. I then blow this out on a slide , let it clot and use it as a cell block. I never hesitate to ask for additional passes if I question the adequacy of the material.  Let the radiologist will tell you when it is time to quit.
  Cruel fact, with the exception of an occasional suprise in the cell block, if the material is of questionable adequacy when I am in radiology or the frozen section room, ofter 
  it remains inadequate when you get it back to the lab! Do not let radiologists and surgeons intimidate you. They will be very happy to share the blame for a second procedure with the pathologist. 
   
  Good luck
   


Stephen Peters M.D. 
Vice Chairman of Pathology
Hackensack University Medical Center 
201 996 4836
 
Pathology Innovations, LLC 
410 Old Mill Lane, 
Wyckoff, NJ 07481 
201 847 7600 
www.pathologyinnovations.com