Collection Manual: Fine needle aspiration

Description: An adequate FNA sample will be cellular and well preserved. Dilution with blood is to be minimized. Successful aspiration is dependent upon proper technique, which may vary with the lesion. A video of FNA technique is available for review. FNA is commonly performed on superficial lesions from the head and neck (thyroid, salivary glands, congenital cysts and lymph nodes), breast and lymph nodes from other body sites. Deep lesions can be aspirated from most body sites under imaging guidance.

FNA KIT: Reagent Alcohol 95% Solution (pre-filled fixative slide-bottle. CAUTION: POISON, FLAMMABLE), Microscope slides, saline for needle rinse, slide mailers, requisition form, FNA worksheet, biohazard transport bag.
CytoLyt™ Solution (CAUTION: POISON, FLAMMABLE) for cyst evacuations, when present. Separate from kit.

1. Complete a requisition form & an FNA Worksheet. Lack of data may result in delay. Include:
• Clinician name, location and date of service.
• Patient demographics: Name, address, phone number, date of birth and social security number.
• Insurance information: copy of insurance card(s) or face sheet.
• Specimen description, including:
a) Site or organ: thyroid, axillary lymph node, breast, etc.
b) Position: laterality, upper, outer, 6 o’clock, subareolar, deep, superficial, etc.
c) Description: size, texture (hard, soft, cystic, rubbery), cystic component, duration, rate of growth, etc.
• Patient history: previous pathology, family history, imaging results, fever, pain, suspected diagnosis, etc.
• Related treatment including antibiotics, radiation, chemotherapy and surgery.

2. Label the slides and saline jar with the patient’s first and last name.
• Label the saline jar and several slides in pencil (ink dissolves in processing). Do not label the slide mailers.

3. Evacuate prominent cysts, if present, prior to aspirating the solid mass.
• If there are only a few drops of cystic fluid, prepare slides per instructions in section 6 below.
• If there is 1 ml or more, express the evacuated cyst fluid into a labeled CytoLyt jar.

4. Collect multiple passes of solid lesions.
• Three passes are usually sufficient for the diagnosis of a solid lesion.
• Use a new syringe and needle for each pass.
Collection procedures 2.11, page 1 of 2

5. Aspirate the solid mass.
• Insert the needle into the mass at a 90º angle.
• Apply appropriate vacuum to the syringe:
a) Moderate vacuum for non-bloody lesions.
b) Minimal vacuum for very bloody lesions, to avoid diluting the sample with copious amounts of blood.
c) More vacuum or a larger gauge needle for fatty or fibrous lesions.
• Move the needle, within the mass, in a back and forth cutting motion. Keep the needle tip within the mass.
• Change the angle of the needle to aspirate different areas of the mass.
• Release the vacuum.
• Withdraw the needle at a 90º angle.

6. Prepare 2 slides per pass.
• Prepare 2 slides per pass. Label one slide AD, for air-dried. The unlabeled slide is to be fixed.
• Carefully, remove the needle from the syringe.
• Apply vacuum to the syringe. The vacuum will be used to expel material from the needle.
• Reattach the needle.
• Angle the needle so the bevel is flat against one of the slides. This reduces exposure of the specimen to air.
• Express the entire needle contents onto the slide.
• Use the second slide to smear the specimen, allowing a second or two for the sample to spread between the slides.
• Gently pull the slides apart, top to bottom, smearing the sample across the slides. Do not press the slides together or the cells may be crushed.
• Immediately immerse one slide in the Reagent alcohol slide jar. Even a few seconds delay introduces nuclear degeneration.
• Allow the slide labeled AD to air-dry (fanning the slide to hasten drying will enhance the smear), then place it in a slide mailer.
• Rinse the needle contents into the saline vial:
a) Open the saline vial and draw saline up through the needle into the syringe hub.
b) Express the rinse back into the saline vial.
c) Collect the needle rinses from all passes into one saline vial
• For multiple passes, repeat steps 5 and 6. Use a new needle and syringe for each pass.

7. Submit in a biohazard transport bag.
•Submit air-dried slides in plastic slide mailers.
•Verify that all jar lids are properly seated and tightened.
• Seal the slide mailers and collection jars in the zip-loc portion of a transport bag.
• Place the requisition form and FNA Worksheet in the outer sleeve of the transport bag.

8. Refrigeration is not required.