Stephen Peters M.D.
petepath <@t> yahoo.com
Thu Mar 2 07:08:11 CST 2006
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.
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
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