A triage system for processing fine needle aspiration cytology specimens

Area of Science:

• Cytopathology
• Surgical Pathology
• Laboratory Medicine

Background:

• Fine needle aspiration (FNA) is a widely used diagnostic technique.
• Poor specimen preparation is a significant cause of nondiagnostic FNA samples.
• Standardized protocols are needed to improve FNA specimen quality.

Purpose of the Study:

• To develop and evaluate a tiered triage system for handling and preparing FNA specimens.
• To minimize nondiagnostic FNA specimens through optimized preparation techniques.
• To enhance diagnostic yield and efficiency in various clinical settings.

Main Methods:

• A three-tiered system for FNA specimen processing was implemented.
• Tier 1: Indirect preparation (rinsing into 50% ethanol, Cytospin, Papanicolaou stain) for aspirations without a cytotechnologist.
• Tier 2: Both direct and indirect preparations when a cytotechnologist is present.
• Tier 3: Rapid staining (modified toluidine blue-eosin) of alcohol-fixed direct smears for immediate interpretation.

Main Results:

• The indirect method (Tier 1) yields results comparable to direct smears and allows for immunocytochemistry.
• Immediate interpretation using modified toluidine blue-eosin stain (Tier 3) provides rapid diagnoses (<90 seconds) with excellent nuclear detail.
• The triage system effectively optimizes specimen processing across different clinical scenarios.

Conclusions:

• The developed three-tiered triage system provides a flexible and effective approach to FNA specimen handling and preparation.
• This system addresses the challenge of nondiagnostic specimens by standardizing processing based on available resources and diagnostic needs.
• Implementation of this system can improve the reliability and efficiency of FNA cytology in diverse healthcare settings.