Available online 15 June 2022

Abstract

The second part focuses on my practice of USGFNA of lymph nodes, salivary glands, lesions of the head and neck, and breast masses. My experience with the handling and triage of various sorts of specimens, core needle biopsies, and cytology report timelines, with real-life anecdotes, is provided at the end.

Introduction

This second part focuses on my clinical practice of ultrasound-guided fine-needle aspiration (USGFNA) of lymph nodes (LNs), salivary glands, lesions of the head and neck, and breast masses. My experience with the handling and triage of various sorts of specimens, core needle biopsies, and cytology report timelines, with real-life anecdotes, is provided.

Section snippetsLymph nodes

The clinical history, physical exam, and US characteristics are important when evaluating a patient with lymphadenopathy.

Taking the Clinical History

Scalp. The most common masses are sebaceous cysts. However, kidney, thyroid, lung, prostate, and breast malignancies may metastasize to the scalp.

Neck. Masses, other than lymph nodes are often found incidentally and are usually asymptomatic. A visible midline neck lesion is usually a TGDC that moves vertically with swallowing and tongue protrusion.

Examining the Patient

Scalp. A pulsatile mass suggests a vascularized metastatic tumor, i.e., renal cell or papillary thyroid carcinoma. Patients with multiple myeloma may

Taking the Clinical History

As a preamble, I will describe three illustrative cases I have seen in my practice.

1) A 72-year-old woman self-identified a small “nodule” in the right supraclavicular fossa and an area of induration with skin puckering in the lower inner quadrant of her ipsilateral breast. USGFNA diagnosed breast carcinoma with LN metastases. 2) I witnessed a case of blastomycosis of the breast, diagnosed by FNA in a young woman, presenting as a rapidly growing mass invading the pectoralis muscle. The

Smears

In general, I prepare 3 to 4 smears; 2 to 3 air-dried and one 95% ethanol-fixed to be stained with May Grunwald Giemsa (MGG) and Papanicolaou stains respectively. I do not use liquid-based cytology except for evaluation of breast hemorrhagic cyst contents.

I do ROSE using Toluidine blue when additional samples are needed for ancillary studies, i.e., cultures, cell block, flow cytometry.

Thyroid molecular tests

I harvest material for thyroid molecular testing when I identify intermediate- or high-risk US features. One

The cytology report

The report is issued within 24 hours. It includes clinical data, physical exam, US findings, a microscopic description, diagnosis, comment, US images and photomicrographs, and 1 to 3 bibliographic references. A clinical, cytologic, and US correlation is included in the comment if relevant for patient management.

Conclusions1

An accurate cytologic diagnosis is based on the clinical history, physical exam, US findings, and adequate smear preparation and processing in the laboratory.

2

Ancillary tests are complementary and must be used judiciously.

3

To maximize diagnostic accuracy and optimize patient care, the Cytopathologist must be the professional who interviews and examines the patient, performs the US and USGFNA, and harvest and interprets the cytology samples.

4

By strictly following such steps, I believe that

Uncited References

1,2

References (2)RH BardalesThe Invasive CytopathologistUltrasound Guided Fine-Needle Aspiration of Superficial Masses. Essentials in Cytopathology Series

(2014)

JS. AbelePrivate Practice Outpatient Fine Needle Aspiration Clinic: A 2018 Update

Cancer Cytopathol

(2018)

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© 2022 Published by Elsevier Inc.