Fine Needle Aspiration of
Various Organs and Body Sites
Fine-Needle Aspiration Biopsy Techniques
William J Frable
H isto ry o f A s p ira tio n B io p sy
C o n c lu d in g R e m a rk s
C lin ic a l S k ills R e q u ire d
A p p e n d ix
T h e T h in -n e e d le A s p ira tio n M e th o d
E q u ip m e n t
T r a in in g a n d P la n n in g
S t a in in g T e c h n iq u e s
B a sic E q u ip m e n t
1. P a p a n ic o la o u S ta in
A n c illa r y E q u ip m e n t a n d S p e c ia l P ro c e d u re s
2. R a p id P a p a n ic o la o u S ta in 46
A s p ira tio n T e c h n iq u e
3. D if f - Q u ik S ta in S e t
P e r fo r m in g t h e A s p ir a t io n
4 . M o d if ie d M a y - G r ΓΌ n w a ld - G ie m s a S ta in
S m e a r P re p a r a tio n
5. H e m a t o x y lin - E o s in S ta in
F ix a tiv e s a n d S ta in s
O th e r T e c h n iq u e s
A n c illa ry T e c h n iq u e s a n d A p p lic a tio n s
C e ll B lo c k P re p a r a tio n
O rg a n iz a tio n o f th e A s p ira tio n B io p s y S e rv ic e
S a p o n iz a tio n
C o m p lic a tio n s o f F in e N e e d le A s p ira tio n B io p sy
S u p r a v ita l S ta in
History of Aspiration Biopsy
The use of fine-needle aspiration (FNA), a method of aspira-
tion biopsy cytology, continues to grow both in North America
and throughout the World.1
Improvements in imaging, com-
puted tomography scan (CT), and ultrasound (US) have fueled
the growth of FNA among both interventional radiologists and
clinicians.2,3 Endoscopic ultrasound is already used widely by
gastroenterologists and radiologists to investigate lesions within
both the abdomen and chest.4-7 An increasing number of targets
for aspiration biopsy are discovered incidentally during investi-
gation of the abdomen and chest for often nonspecific or vague
symptoms. The term "incidentaloma" has gained credence in
the medical literature, primarily for incidental adrenal lesions,
though this term appears in no recognized classification of
either neoplastic or non-neoplastic diseases.8,9 The dominant
clinical sites for FNA still remain breast, thyroid, and lymph
nodes among superficial tissues. The availability of high-resolu-
tion mammography with stereotactic needle placement has also
focused renewed attention on aspirating non-palpable lesions
of the breast, although the emphasis has shifted over the past
few years to core needle biopsies.10-13 Large bore needles are also
being used to both biopsy and excise small breast tumors, lead-
ing to challenges to surgical pathologists to evaluate margins in
fragmented specimens and assess the risk of invasion when it
cannot be detected microscopically.14,15
Martin and Ellis in 1930 are generally credited with the first
description of sampling of tumors by means of a narrow-gauge
needle.16 This method of tumor diagnosis became quite popu-
lar at Memorial Sloan Kettering Cancer Center through the late
1950s, but was not accepted in any significant way in other US
medical centers.17 The history of aspiration biopsy in Europe
extends back to the mid-nineteenth century, preceding the
invention of the microtome, which then allowed thin sections
of tissue to be cut.18 *
Almost immediately after World War II, an
experienced group of Swedish clinicians trained chiefly in hema-
tology and oncology led a resurgence of the application of aspi-
ration cytology.19-21 Aided by several clinicians and pathologists
who studied with the group in Sweden in the early 1970s, FNA
again gained considerable prominence in the United States as
a useful biopsy method for tumors.22 Growth of imaging meth-
ods and the specialty of interventional radiology has certainly
provided additional fuel to the expansion of aspiration biopsy
and has in recent times shifted this biopsy method away from
exclusively aspiration and toward microcore biopsies either
alone or in combination with aspiration.23-26 Some comprehen-
sive technology assessment of aspiration biopsy has now been
carried out. FNA is generally cost-effective for superficial masses
but may be only marginally so for deeper lesions where both
pathologists and radiologists are involved and considerable
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