Ch. 8 - FNA Technique Flashcards
What equipment is needed to perform FNA?
Disposable needles, syringes, syringe holder, alcohol wabs & gauze, slides, fixative, fluid transport medium, slide holders, maybe local anesthesia.
What should be reviewed in the patient’s history before needling?
History of clotting disorders or anticoagulants.
What position is preferred for sampling breast lesions? Neck lesions? Lesions with overlying muscle?
Breast: Arm raised over head
Neck: Patient sitting upright
Under muscle: Any position such that the muscle is relaxed.
What should be done for vascular or sclerotic lesions?
Use a finer needle.
In what direction should a lesion be sampled?
Ideally, along its longest axis.
What does it mean to “feel with the needle”?
Tactile feedback during needle passes; cancer feels “gritty”, fibroadenoma feels rubbery, fat feels soft.
Why should samplings be limited to 3-4 passes?
More attempts will result in hemorrhage, diminishing diagnostic yield.
What is the “Zajdela” technique?
AKA “French technique”, uses a needle with no syringe.
What are some serious possible complications of FNA?
Pneumothorax, artery dissection, seeding of tumor cells (unlikely)
During FNA, a patient begins thrashing. What should be done with the needle?
Do not remove until the patient’s movement stops.
Distinguish between the one-smear and two-smear methods of preparing cell smears.
One smear: Hold slides perpendicular to each other. Results in very little material on the spreader.
Two smear: Hold slides parallel. Trickier.
How should cystic masses be approached by FNA?
Try to drain as much as possible. Keep fluid in a container for processing.
Material is stuck in the needle hub. How can it be extracted?
Stick the needle into the cap of a vacutainer or similar. Flick the needle hub against the slide.
What liquid mediums are most versatile for ancillary studies?
Saline and RPMI (can be used for flow cytometry and traditional karyotyping).
How can smear slides be repurposed?
Can soak in xylene and scrape for cell block (if not already stained). Can also scrape for molecular testing even if stained (DQ).
