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Practice Statement

Powers, Celeste N. MD, PhD; Jakowski, Joseph D. MD

doi: 10.1097/PCR.0b013e318281c88c
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Medical College of Virginia Hospitals, Virginia Commonwealth University Health System Richmond, VA

Joseph D. Jakowski, MD, Adele O. Kraft, MD and Celeste N. Powers, MD, PhD

We are an academic medical center with surgical and cytopathology laboratories with a well-established “on-demand” palpation-guided fine-needle aspiration biopsy (FNAB) service for more than 40 years. Our current yearly FNA volume is more than 1800 specimens. In 2011, we added ultrasound-guided FNAB to our cytopathology service with support from the Medical College of Virginia Hospitals that included 2 ultrasound machines and a certified ultrasonographer.

We have a close working relationship with our clinical colleagues in endocrinology, surgical oncology, and otolaryngology and perform biopsies on a wide variety of superficial body sites, which makes up nearly 30% of our yearly FNA volume. Currently, we are developing a dedicated FNAB clinic for outreach and ambulatory clinic patients, which is designed around our ultrasound-guided FNAB service. We are additionally training pathology residents as well as cytopathology and endocrinology fellows in ultrasound-guided FNAB.

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University of California at San Francisco, San Francisco, CA

Elham Khanafshar, MD, and Britt-Marie Ljung, MD

We are an academic center with comprehensive cytopathology services that initially started to offer an on-demand FNA service 34 years ago in 1979. Ten years ago, we acquired space for a dedicated pathologist-directed FNA clinic with 2 examination rooms and dedicated, staffed reception area. The clinic is located conveniently adjacent to the cancer center, near many outpatient clinics and immediately adjacent to cytopathology faculty offices. We introduced ultrasound-guided FNA (USFNA) in our clinic about 3 years ago. We provide drop-in service for patients from our academic institution as well as for patients referred specifically for FNA from private practices in the area, mostly ear, nose, and throat surgeons and endocrinologists. We train 2 cytopathology fellows per year in all aspects of cytopathology including USFNA. Pathology residents rotate through the service and get comprehensive training in conventional cytology, experience in performing palpation-guided FNA, and introductory training in USFNA. Our FNA case load at this location is approximately 3000 per year. Our total departmental FNA case load including other campus sites is approximately 4500. We are currently in the process of planning additional outreach, targeting both departments within our institution and providers in private practice in the area to expand our service including USFNA.

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Massachusetts General Hospital, Harvard Medical School, Boston, MA

Amy Ly, MD, Martha B. Pitman, MD, and Rosemary Tambouret, MD

We are a large, academic medical center with surgical and cytopathology laboratories and a well-established superficial, palpation-guided FNAB service since 1991. A dedicated pathologist-directed FNA clinic was established in 2001. In 2010, we purchased an ultrasound machine for FNA guidance to be used by the pathologist in difficult cases. Because the more than 2500 thyroid FNAs at our institution are performed by well-trained and skilled endocrinologists, our goal was not necessarily to perform thyroid FNAs. We have no certified ultrasonographer. Of 6 FNA pathologists, 2 have been certified by the College of American Pathologists for USFNA, and another FNA pathologist has attended an American Society of Cytopathology course on USFNA. We incorporate some training in ultrasound-guided FNAB into the curriculum for pathology residents and cytopathology fellows, but a formal didactic training program has not yet been established.

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Outpatient Pathology Associates, Sacramento, CA

John S. Abele, MD

We are a private practice pathology group that initially developed in 1982 as an outpatient FNAB clinic and a dedicated outpatient surgical pathology unit in response to services needed for a large private medical group. Five years later in 1987, we formed Outpatient Pathology Associates as a pure outpatient pathology practice focusing on an FNAB diagnostic unit, a surgical pathology service with a strong gynecologic emphasis and gynecologic cytopathology. We introduced ultrasound-guided FNAB in 2003 and currently average 10 to 12 biopsies per day. In 2011, we accessioned more than 6500 clinic and referral FNA cases from more than 200 physicians in more than 20 states. Our practice has additionally offered a hands-on FNA educational practicum that is individually tailored to meet the needs of both clinicians and pathologists desiring to learn all aspects of FNA technique.

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Englewood Hospital Medical Center, Englewood, NJ

Miguel A. Sanchez, MD, and Mikhail Tismenetsky, MD

Englewood Hospital is a 540-bed community hospital affiliated with Mount Sinai School of Medicine. Our Leslie Simon Breast Care and Cytodiagnosis Center has been providing imaging and cytopathology services since 1991. We currently perform approximately 6500 FNAs per year done by radiologists and pathologists with and without ultrasound guidance. Pathology residents from Mount Sinai School of Medicine spend 2 months in our clinic, learning and assisting in the performance of FNAs. The clinicians that we serve include primary care physicians, gynecologists, breast surgeons, endocrinologists, and nurse practitioners. Approximately 70% of our FNAs are of breast lesions, followed by thyroid nodules, lymph nodes, salivary gland, and soft tissue masses. In our center, we see patients daily, and every FNA room is equipped with an ultrasound machine (a total of 9 ultrasound units—8 floor models and 1 portable model). Ultrasound is used as part of a physical examination to obtain additional information that cannot be ascertained just by palpation.

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