[Histonet] FNA'S

[Kemlo Rogerson]

We tend to air dry our FNAs and to look at one for ROSE (rapid onsite
evaluation) to gauge adequacy. The air dried sample is stained with
Diff-Quick and looked at onsite.

I tend not to make 'blood films' as that disrupts cells, especially oat
cells, and you end up with debris, smear cells, etc. I quickly (very
quickly) deposit a spot of the fluid onto a slide and touch the face of
another clean slide flat on top with the slides at 90 degrees to each other
with NO shearing motion; the slides are then pulled apart. They are then
dried; these touch slides tend not to have any artefact caused mechanically.

You can fix rather than air dry when you pull the slides apart with a spray
fix.
           

Kemlo Rogerson
Pathology Manager
Ext  3311
DD   01934 647057
Mob 07749 754194
 

"Following the line of least resistance makes both men and rivers crooked"

-----Original Message-----
From: Stephen Peters M.D. [mailto:petepath <@t> yahoo.com] 
Sent: Thursday, March 02, 2006 1:08 PM
To: Histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] FNA'S

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 




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