of smears, single-end frosted slides should be utilized.
Slides should be labeled with patients first and last name
and specimen source in pencil prior to aspiration. Some investigators
recommend to first gently express a drop of aspirated fluid onto
a slide, while others recommend forcefully expelling the material
onto the slide. The actual method will be determined in part
by the nature of the material present. A drop may be easily expressed
without force if the aspirated material is abundant and fluid.
If the material is scant, or more viscous or solid, the material
must often be forcefully expelled. The latter method can result
in splattering of material off of the slide and will utilize
most of the specimen resulting in the preparation of a minimal
number of smears necessitating more passes if additional material
is required for additional studies. The former method allows
for better control of the smear process.
Once the specimen is on the slide, it must
be smeared. The simplest way to accomplish this is to place a
second glass slide onto the first (Figure
a) To prepare smears, place the bevel of
the needle directly on the glass slide near the frosted end.
Express the aspirated material using the air-filled syringe to
blow out material through the needle onto a slide in one drop.
Do not spray the specimen through the air onto the slide.
b) A second or spreader slide is then used to make the smear.
The spreader slide is gentle lowered, crosswise, over the droplet,
which will then spread out slightly by capillary action. The
spreader slide is then gently pulled straight back in one smooth
motion, down the length of the diagnostic slide. Little or no
diagnostic material should remain on the spreader slide.
c) Repeat the above procedure with additional drops of material
to make approximately 4-6 slides. Any material that remains can
be expressed into CytoRich Red cytology preservative (unless
lymphoma is suspected and then place material in RPMI media).
We prefer that air-dried smears be prepared from thyroid fine
needle aspirations specimens. Do not prepare air-dried smears
from other specimens sources unless discussed first with the
Cytopathology Department. Follow the same procedure for preparing
slides, as outlined above, when preparing air-dried smears except
for the fixation step. For thyroid aspirations we recommend several
unfixed slides be prepared in addition to several fixed smears.
In addition, material may be submitted in CytoRich Red
The smears should be:
1) Immediately fix the slides in 95% ethanol for Papanicolaou
staining (delineate with an F, for fixed, on the
frosted end of the slide).
2) Air-dried smears for Diff-Quick staining should be prepared
for thyroid specimens only (delineate with an A,
for air-dried, on the frosted end of the slide).
3) If spray fixative is used, spray 10-12 inches from slide immediately
after the smear is made. Additional smears may be prepared if
material remains in the hub of the needle or the material may
be entirely rinsed into a specimen container containing either
fixative CytoRichTM Red, CytoLyt or a physiologic solution such
as normal saline (or RPMI if lymphoma is suspected). All of the
aspirated material should be flushed into a physiologic solution
if smears are not prepared. The advantage of submitting material
in CytoRich Red cytology preservative is that cell block
material can be prepared which facilitates utilization of special
stains in evaluating the specimen. Please submit material in
RPMI solution if lymphoma is suspected (arrange with the laboratory
in advance by calling 202-2888 and request the clinical pathologist
on call or the Tissue Laboratory at 202-1745).
Submit the specimen (smears and/or material rinsed into solution)
to the Cytopathology Laboratory along with the completed test request form. The specimen should
be submitted in fixative if transport of specimen in fluid will
be delayed more than 24 hours.
Specimen stability: If transport time of fluid specimen will be less
than 24 hours or fixative is not available then refrigerate the
specimen (or keep on wet ice) until transport to the Cytopathology
Reference interval: By report.
CPT code(s): 88173
This CPT code may also be reported in conjunction with aspiration
of the specimen (10021) and/or immediate on-site evaluation of
the specimen (88172). Additional CPT codes may be reported depending
on the preparation methods, such as 88106, 88108, and/or 88305.
Fine Needle Aspiration Collection
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