Building an USGFNA clinic from scratch: A recipe from the USGFNA cookbook for successes

Cytopathologist optimized ultrasound-guided fine needle aspiration biopsy (USGFNA) seeks to integrate all available sonographic and cytologic information into a single diagnostic report, usually ending with a final statement that the biopsy does or does not explain the clinical, sonographic and cytologic features of the nodule. The experience needed to fully realize this goal is best acquired in a dedicated USGFNA clinic. There the cytologist reviews the clinical record, available sonographic images and reports, personally performs a sonographic evaluation resulting in ACR 2017 TIRADS cancer risk assessment of each nodule, identifies the one or two nodules with TIRADS indication for biopsy, the samples the nodule(s) under sonographic guidance, creates well-crafted distortion free smears, completes the microscopic evaluation, and writes a final comprehensive report. This review draws on my personal and published experience in introducing cytopathologists to USGFNA and presents ten specific items for which a cytopathologist needs to acquire both background knowledge and technical skill to successfully introduce USGFNA into an existing pathology practice. This review is written from the perspective of the head and neck clinic but can be adapted to any site appropriate for USGFNA.