Photo by Sharon Renee Taylor
Army Capt. (Dr.) Sarah Heaton, a second-year pathology resident, demonstrates the technique she uses to obtain a superficial mass in the new Fine Needle Aspiration Clinic which recently opened at WRNMMC.
You’ve just noticed a small lump under your skin, or perhaps your doctor has told you that a lump was discovered in your thyroid gland or your breast. That means that you need surgery, doesn’t it?
Not necessarily. There is a method of diagnosing lumps and bumps that is as simple as having your blood drawn, and its uses has expanded over the past decade as testing becomes more sophisticated.
The procedure is called Fine Needle Aspiration (FNA), practiced by many physicians at the Walter Reed National Military Medical Center (WRNMMC). The procedure involves placing a needle (smaller than one used to draw blood) into lumps and collecting the cells to make a diagnosis. The cells are smeared onto glass slides, stained, and reviewed under a microscope for adequacy by a specially-trained individual called a cytotechnologist. These slides are immediately evaluated and interpreted by pathologists, who usually provide an exact diagnosis of the lump.
The Pathology Department recently opened a new FNA clinic at WRNMMC, where health-care providers can refer patients for this procedure. The Pathology FNA clinic is designed to give health-care providers an immediate answer to the question: what is this mass and how should it be treated? It also provides patients with the opportunity to obtain a same-day diagnosis without scheduling another clinic visit. Only superficial masses are aspirated at the pathology FNA clinic, but ultrasound-guided FNA is also available for superficial masses, such as those in the thyroid.
There are advantages to having a pathologist perform FNA procedures and evaluate the slides immediately. Pathologists interpret and make a diagnosis on all FNA specimen slides, so they are aware of the necessity of having high-quality slides and staining to make an accurate diagnosis. Pathologists who review all specimen collections immediately on site know when they need to collect additional specimen for special tests, which may prevent the patient from returning to the medical center for a second aspiration. Pathologists also know what specimen special studies are needed to help make a diagnosis, and can separate or collect more samples for those additional studies. This immediate "triage" step can prevent additional unnecessary procedures for the patient, such as repeat FNAs.
Prior to the FNA procedure, pathologists review patient electronic records and radiographic studies, as well as perform a clinical history and physical examination related to the mass. The entire procedure takes about 30 minutes, but appointments are generally scheduled for an hour at a time to allow patients and pathologists a chance to discuss the findings and implications of the test. Pathologists are available to explain the differential diagnosis of the mass, the likelihood of a particular diagnosis, and the typical disease progression of lesions and tumors. Patients and families should feel comfortable asking questions about their disease during these visits. Often after reviewing the initial slides, the pathologist has a general idea of the category of disease and/or the diagnosis and can discuss this with the patient. When additional studies are necessary, or the cellular collection is scant, the interpretation of the slides may take longer.
Patients are accepted on a walk-in basis and as immediate referrals from WRNMMC clinics. Pathology FNA clinic hours are from 9 a.m. to 3 p.m., Monday through Friday. Appointments can be made by calling the Department of Pathology, Cytopathology Service, at 301-295-2100. The clinic is located in Arrowhead Building 9, second floor, Room 4710, in the same area as phlebotomy, across from the cardiology department. Patients should report to the Laboratory Main Desk.