FINE NEEDLE

ASPIRATION CYTOLOGY
( FNAC )
 DEFINITION

• REMOVAL OF A SAMPLE OF CELLS FROM A TARGET MASS OR

LESION USING A "FINE NEEDLE" ( 22 GAUGE OR SMALLER I.E
23,25,27 G ) FOR DIAGNOSTIC PURPOSES IS CALLED FINE NEEDLE
ASPIRATION CYTOLOGY.
 FNA TARGET

• A LUMP OR BUMP THAT IS

CLINICALLY SUSPICIOUS OR
MAY AFFECT THE PATIENT
MANAGEMENT
CORE NEEDLE BIOPSY – AN EXAMPLE
 PRINCIPLE

• THIS TECHNIQUE IS BASED ON THE FACT THAT TUMOR CELLS ARE

LESS COHESIVE AND ARE EASILY ASPIRATED.
MOST COMMON ANATOMIC
SITES FOR SUPERFICIAL FNAS
01 02 03 04 05
Thyroid Breast Lymph node Salivary Subcutaneous
glands soft tissue
Liver Lung Pancreas

Kidney Peritoneum

DEEP SEATED LESIONS

INDICATIONS
Diagnosis in instead of surgical tissue biopsy ( As anAlternative )

Therapeuticcyst/abcessdrainage

Collection of specimen forspecial

studiessuch as flow cytometry or culture.
 The ill definedindurations,
clinicallyinsignificantlymph
FNA is not for every minor nodes,
swelling or abnormality andvagueinflammatory
conditions are poor FNA
targets
ADVANTAGES AND
LIMITATIONS
 Simple - Outpatient, minimal pain & complications, no
anesthesia, No pre/post procedure restrictions, can be
repeated, no scars, does not interfere with further study

Accurate - High sensitivity, specificity and accuracy

(>95%).
ADVANTAGES
‘SAFE’
Fast - 20-30 minute procedure with rapid results

Economical - cost-effective , NO special kits are not

needed.
 Lackoftissue architecture, especially in instances in which
documentation of capsular or vascular invasion may be
necessary to confirm malignancy ( e.g.Follicular Ca )

LIMITATIONS FNAs requiresconsiderable trainingand experience for

accurate diagnosis.

FNAs are also difficult to perform on children less than 13

years old without the assistance of the referring physician,
and sedation may be required in some instances.
 EQUIPMENT AND
SUPPLIES FOR FNAC
 Gloves and safety glasses ( Plastic and Latex Gloves )

Face Mask

Needles( 0.75, 1.0, 1.5 inches ) with standardbeveledneedle tip edge

FOR THE Disposableplastic syringes(5, 10 or 20 mL)

DOCTOR
Plastic flexible ruler ( For measurement)

Pen and pencils

Post aspiration biopsy handout informational sheet

 FNAC Table / Dust Bin

Drapes, sheets, gowns, pillows (cover patient/biopsy site,

positioning the patient)

FOR FNAC Sharps container ( as well as needle cutter )

ROOM
Frosted Glass Slides

Slide Holder with Alcohol as a medium

 FOR THE PATIENT

Skin disinfectant: 70% alcohol pads

Local anesthesia (e.g. 1% lidocaine without epinephrine), if needed

Sterile 4 x 4 sponges Or Cotton

Band aids ( Bandages )

Ice bag (to send home with patient if needed)

FNAC ROOM
PARTS OF ASPIRATION
NEEDLE AND SYRINGE
 SYRINGE PARTS

• PLUNGER: MOVABLE PORTION OF THE SYRINGE THAT HAS A RUBBER SEAL AT THE
END AND FITS INTO THE BARREL TO CREATE POSITIVE OR NEGATIVE PRESSURE BY THE
OPERATOR

• BARREL: HOLLOW PORTION OF THE SYRINGE INTO WHICH THE PLUNGER FITS

• ADAPTOR OR SYRINGE TIP: END OF THE BARREL TO WHICH THE NEEDLE HUB IS
ATTACHED

• SCALE: UNIT OF VOLUME MEASUREMENT PRINTED ON THE BARREL

 Hub or needle adaptor: portion of needle
that may be attached to the adaptor or tip
of the syringe

HOLLOW
BORE Shaft: hollow tubular portion of the needle
NEEDLE between the hub and the needle tip

PARTS
Tip: opposite the hub that usually is beveled
to a point and contains a lumen that is
continuous with the hollow shaft and hub
 RISKS AND
CONTRAINDICATIONS
‘OVERWHELMING VOLUME OF
LITERATURE SUPPORTS THE SAFETY OF
FNA’
 Minor pain / discomfort (increases
with needle size)
MOST
COMMONLY
ENCOUNTERED
Bleeding (ecchymosis / hematoma)
COMPLICATIONS
/RISKS

Rarely vasovagal reaction

(lightheadedness / fainting) or
infection
 Pneumothorax
(with trans- Infections (In
thoracic Needle active Prostatitis)
Biopsy)
 Bleeding disorders or anticoagulant therapy: ESP. H
& N (Eg. thyroidRisk bleeding / hematoma
formationmass effect leading to airway compromise

For Thyroid: For those who cannot suppress theircough

reflex: Risk of laceration by needle
CONTRAINDICATIONS

Uncooperativeor excessively apprehensivepatient

Certaintumorsand tumor like conditions ( Seeding )

Patients with active Prostatitis

Suspected vascular lesions (arterio-venous malformations, angiosarcoma)

Advanced pulmonary emphysema

Severe pulmonary hypertension

Severe hypoxemia
 Vascular tumors
SITES OF LESIONS Pheochromocytoma
ASSOCIATED
WITH INCREASED Hepatocellular carcinoma
RISK OF
COMPLICATIONS
Pancreatic lesions
Infected tissues
BEFORE STARTING THE
PROCEDURE
 Greet Greet the Patient

Introduce Introduce yourself

PRE FNA
PROCEDURE
Review Review any pertinent radiographic imaging ( e.g Ultrasound ) and laboratory

EVENTS studies

Explain Explain biopsy procedure in lay terms, specimen adequacy and waiting time,
obtain informed consent, and reconfirm site of aspiration

Mention Mention to the patient that several passes (averaging 2 - 6 passes) may be
necessary to obtain adequate cells for diagnosis and any other studies
Inquire Inquire about any significant medical problems including bleeding disorders,
anticoagulation, previous hisotry of syncope & Biopsy procedure Complications.

Inquire Inquire about special clinical requests (e.g. hormone studies, microbial cultures,
thyroglobulin wash out)

Examine Examine the aspiration target / site, especially location relative to the anatomical
structures

Obtain Obtain patient history ( UPCOMING SLIDES )

Address Address any patient concerns about the procedure BEFORE proceeding
• READY ASPIRATION SETUP AND SUPPLIES (NEEDLES,
SYRINGES, SLIDES, SPECIAL COLLECTION TUBES FOR ANY
ADDITIONAL STUDIES)
PATIENT HISTORY
(FOCUSED)
 PATIENT’S HISTORY ( OPQRST )

• Who first noticed the condition?

Onset • Was the onset sudden, gradual or appears to be
chronic

• Example: "How long has the lump been there and

Time (History) how it has changed since onset?"
• "Has this swelling ever happened before?"
Provocation and Palliation
Whether any movement, palpation,
medications or other external factor makes
lesions/symptoms better or worse
Region and Radiation
Example: "Is this the only enlarged lymph
node you have noticed or are there more in a
different area?"
If there is pain in a lump, you can ask if it
extends or moves to any other area
 Quality
This is the patient's description of
associated symptoms, for example pain ( sharp,
dull, crushing, burning, tearing/ also the pattern
intermittent, constant, throbbing )
Severity
If there is pain you can assess with a pain score
(usually on a scale of 0 to 10) or ask as a
comparative such as "... compared to the
worst pain you have ever experienced"
 REQUEST FORM
• HISTORY SHOULD BE DOCUMENTED ON THE REQUEST FORM AS WELL AS
THE PHYSICAL EXAMINATION POINTS
• OTHER RELEVANT HISTORY SPECIFIC FOR THAT AREA / OR THAT IS
MENTIONED IN THE REQUEST FORM SHOULD BE NOTED SUC AS THYROID
( PALPITATIONS, TREMORS ETC ) LYMPH NODE ( FEVER ETC), BREAST.
• SOME GENERAL INFORMATIONAL TO BE DOCUMENTED IS AS FOLLOWS
1. DEMOGRAPHICS INCLUDING FACILITY NAME, PATIENT NAME, DATE
AND TIME OF EXAM, ETC.
2. RELEVANT PATIENT CLINICAL INFORMATION AND PHONE NUMBER
3. WHO PERFORMED THE FNA AND HOW MANY ATTEMPTS DONE
4. AMOUNT/COLOR/CONSISTENCY OF THE MATERIAL ASPIRATED
PHYSICAL EXAMINATION
- LUMP
(FOCUSED)
Site Size Shape Surface Skin Scar
Tenderness,
Depth Consistency Attachment Mobility
Temprature

Pulsation Fluctuation Irreducibility Regional Edges

lymph nodes
Site Size Skin Changes Tenderness

Consistency Mobility Regional

Lymph Nodes

PRACTICAL / PMC PROTOCOLS

JUST BEFORE YOU
START
 Proper patient positioning to access the target

PAY Technique to best immobilize the target

SPECIAL Estimated needle length and size

ATTENTION
TO Use of suction or not during the biopsy

Special collection methods needed (e.g. RPMI for flow cytometry, cell
block, sterile container for cultures, or collection / drainage of cyst
fluid)
WHEN YOU START
 Follow Follow "universal precautions"

Locate and Locate and immobilize target again with one hand
immobilize

Disinfect Disinfect the skin with alcohol (70%) at site of planned needle puncture site

ALWAYS
Pass Pass the needle through the skin in one quick motion

EXCEPTIONS
EXCULDED Approach Usually needle approach is 30 - 45 degree angle to the skin for very superficial
targets and a more perpendicular approach for deep targets

Advance the needle into the Center ( Small Target ) or periphery ( Large Target –
Advance Chance of central necrosis )
 In most cases, the aspirator will notice a difference
in the consistency of the tissue of the target when
penetrated

ONCE YOU Once in the target, you may apply suction, and
HAVE then the needle is moved in long back and forth
cutting motions within the target (DO NOT let the
needle come out of the skin during this motion)
ENTERED
When blood or material appears in the hub of the
needle the aspiration should be stopped
 PROIR to withdrawal of the
needle if using suction,
negative pressure must be

WHEN YOU released.

WITHDRAW
Remove the needle from the patient by pulling
straight out so as not to lacerate the skin of the
patient by angling the needle upon withdrawal

The plunger may or not return to the staring position, In Such

cases DO NOT force the plunger down
 Apply pressure to the aspiration
AFTER YOU site, preferable by an assistant
WITHDRAW Prepare smears and obtain
needle rinses as needed
 GENERAL
CONSIDERATIONS
Usually 2 - 6 passes are performed on the target for adequate
sampling

Each single needle pass should take less than 5 - 10 seconds to

complete, with 10 - 20 excursions.

When sampling vascular targets or the thyroid gland, single pass

should take 2 - 5 seconds and use smaller gauge needles (e.g. 25
or 27 gauge), to decrease hemodilution of the FNA specimen

In general, produce 1 - 2 slides per needle pass for diagnostic

purposes but usually not more than 4 per pass
The needle gets into the target (and preferable stays within it throughout
the biopsy)

Performing the CUTTING action with the needle tip and Limit the time of
the biopsy to less than 5 - 10 seconds

Changing the needle path during the excursions IN a cone shaped

sampling area

redirect the needle only when at the top of the cone (almost withdrawn
from the target) and not at the base ( Chance of laceration )

Use of long amplitude excursion and perform only 2-3 per second
 Inexperience

Quickly performed PRocedure

FAILURE TO Needle has missed to target

OBTAIN A
REPRESENTATIVE Needle in cystic/haemorrhagic/necrotic area devoid of
SECTION diagnostic cells
Needle in dominant benign mass missing a small
adjacent malignant lesions.
Fibrotic/desmoplastic lesion tissue giving a scant cell
yield
FINE NEEDLE BIOPSY
TECHNIQUES
 TYPES OF FNA PROCEDURES

Fine Needle Capillary UltrasoundedG

Aspiration Action Needle uided FNA
Biopsy Biopsy
 COMPARISON OF THE
CAPILLARY ACTION TO
TRADITIONAL FNA
NON ASPIRATION TECHNIQUE VS SUCTION
TECHNIQUE
 Fine Needle Aspiration biopsy Capillary Action Needle Biopsy

Traditional FNA, Suction or Aspiration biopsy The French, Zajdela, Needle only or Non aspiration
Technique

Needle biopsy using suction (negative pressure) by attached Does not use suction (negative pressure) during the biopsy
syringe

DO NOT pump the syringe Relies solely on capillary action of the needle

Syringe may be directly attached to needle OR IV tubing Only the needle is used
may be placed between needle and syringe

Steady suction during the needle excursion is recommended Rotating the needle during the excursions may be helpful to
increase the yield
 Traditional (suction) FNA
May provide larger yield of cells
Comparatively more hemorrhage / bloody specimens
Less tactile sense to "feel" the consistency of the target (fingers
are farther away from the needle)
Equipment may be more alarming to the patient because of the
addition of the large syringe and syringe holder
Less fine motor coordination of the needle tip (uses wrist, arm and
shoulders to control sampling)
Chances of causing trauma to cells and tissues
Can be used to drain cystic lesions or perform therapeutic
decompression of a target if needed
Capillary (non aspiration technique)
May yield fewer cells but provides sufficient material for diagnosis
Less hemorrhage / bloody specimens and higher concentration of cells
in the specimen
Better tactile sense to "feel" the consistency of the target (fingers are
closer to the needle)
Less "scary" to the patient as this small needle only technique
may be concealed within your biopsy hand
Increased fine motor coordination of the needle tip and thus
increased sampling precision (using fingers to control sampling);
May be more useful for very small targets
Reduces trauma to cells and tissues
However, cannot drain cystic lesions or perform therapeutic
decompression of a target if needed
 The literature is conflicted regarding the
superiority of one technique over the
other; they may be used consecutively
during a single procedure if needed
TECHNIQUE
OF CHOICE
Personal preference and teaching
exposure will probably influence the
FNA technique of choice; however, it is
advantageous to be familiar and
proficient in both techniques
VARIABLES THAT INFLUENCE
AMOUNT OF SPECIMEN
COLLECTED INCLUDE

Suction (force, duration and
rate of increase)
Needle (size, content, tip
configuration)
Needle movement (number,
frequency and amplitude of
passes, angle between the
passes, acceleration of
movement)
Type of target tissue
 TYPE OF FNA MATERIAL
OBTAINED FOR SMEAR MAKING
THREE GENERAL CATEGORIES OF PHYSICAL PROPERTIES OF FNA MATERIAL WHICH
SUGGEST HOW TO TRIAGE THE MATERIAL AND WHAT SMEAR MAKING METHODS TO USE
 Distinct firm fragments of visible material that appear in background of
other fluid or semisolid material or are expressed out as a single
"core" or as fragments in a clean background

Often difficult or impossible to smear as a monolayer

May roll about the slide, leave "streak marks" or be

SOLIDS extensively crushed if smearing is attempted

Often create air bubbles under cover slips as they are very thick

Examples: tissue fragments from very firm sarcomas, fibrous / scar

tissue or even normal skeletal muscle
 • MOST COMMON ASPIRATE MATERIAL OBTAINED, CONSISTING OF VISIBLE
MINUTE SOFT PARTICULATE MATERIAL OFTEN IN A SLIGHTLY BLOODY
BACKGROUND
• TENDS TO BE MODERATE TO HIGHLY CELLULAR MATERIAL AND OFTEN
YIELDS GOOD MATERIAL FOR DIAGNOSIS UNLESS NECROTIC
• PARTICULATE MATERIAL TENDS TO SPREAD EASILY ABOUT THE SLIDE WHEN
SMEARED

SEMISOLID • MAY CAUSE "THICK SMEAR" WITH DIFFICULT INTERPRETATION IF TOO

MUCH MATERIAL PLACED ON SLIDE FOR SMEARING OR IF CONCENTRATED
TOO MUCH IN A LIMITED AREA
• CREATES LOW TO MODERATE HYDROSTATIC FORCES BETWEEN SMEARING
SLIDES
• EXAMPLES: TUMOR AND TUMOR LIKE CONDITIONS INCLUDING SOLID
THYROID NODULE, LYMPH NODE, BREAST TUMOR, ABSCESS, EPIDERMAL
INCLUSION CYST
 • OFTEN ACCOMPANIED BY OILY DROPLETS ON SMEAR SLIDE
ADIPOSE • DOES NOT AIR DRY WELL AND STAYS "GREASY"
TISSUE AND • IS HYDROPHOBIC, AND DOES NOT STAY ON SLIDE VERY
FATTY / LIPID WELL AFTER STAINING
• EXAMPLES: ASPIRATES FROM FAT CONTAINING TUMORS
CONTAINING SUCH AS LIPOMA OR WELL DIFFERENTIATED LIPOSARCOMA
MATERIAL
 • WATERY LIKE MATERIAL THAT DOES NOT "STICK" TO THE
SLIDE VERY WELL
• TENDS TO RUN ALL OVER THE SLIDE WHEN SLIDE IS TILTED
EVEN SLIGHTLY
• USUALLY HAS VERY LOW CONCENTRATION OF CELLS
FLUID • CREATES HIGH HYDROSTATIC FORCES BETWEEN SMEARING
SLIDES
• EXAMPLES: THIN SEROUS FLUID FROM THYROID CYSTS,
FIBROCYSTIC CHANGES IN BREAST, SEROMA
SMEARING
 When expressing the material out of the needle using positive
pressure from the syringe, keep the needle tip's beveled
edge in contact with the glass slide surface using a 45 to 90 degree
angle to the surface of the slide

TRANSFERRING
Make sure needle is easily removed from syringe tip BEFORE
FNA MATERIAL aspiration occurs and do not spray the material to avoid drying or
breaking of material
FROM NEEDLE
ONTO GLASS Clear everything / everyone from path between aspiration site and
SLIDE slide making site as you will be moving rapidly between those areas
with a "dirty needle"

Make smears immediately after you place material onto glass slide
(seconds count) as delaying may cause clotting and trapping of the
material.
 Personal preference and teaching exposure
influence the method of choice but the physical
properties of the FNA material
TYPES OF
Express the FNA material on the slide so that it is
SMEAR about 2/3 the way up from the non frosted end of
the slide
MAKING
Generally, one to two drops forming a single large
METHODS droplet of semisolid FNA material should suffice per
slide (1 drop = ~.05 mL)

For cyst fluid or liquid material, several drops up to

0.5 mL may be placed on the slide and concentrated
using the special methods below
 • HOLD UP A SLIDE WITH THE DROPLET OF FNA MATERIAL (THE "NON SPREADER" SLIDE); THE DROP SHOULD
FACE YOU AND THE NON FROSTED END SHOULD POINT AT A STEEP ANGLE TOWARDS THE FLOOR; USE
YOUR NON DOMINANT HAND BY HOLDING THE FROSTED END PINCHED BETWEEN YOUR THUMB AND
INDEX FINGER AND USE THE REMAINING FINGERTIPS OF THIS HAND TO SUPPORT THE BACK OF THE SLIDE

ONE STEP
A SECOND SLIDE, CALLED THE "SPREADER SLIDE", IS THEN BROUGHT UP WITH THE DOMINANT HAND BY
GRASPING IT BY THE FROSTED END PINCHED BETWEEN THE THUMB, INDEX AND THIRD FINGER TO A
POSITION THAT IS PERPENDICULAR ABOVE THE "NON SPREADER" SLIDE

SMEAR • KEEPING THIS PERPENDICULAR ORIENTATION, THE MIDDLE OF THE "SPREADER SLIDE" IS THEN POISED OVER
THE SPECIMEN DROPLET ON THE "NON SPREADER" SLIDE WITH ITS LOWER EDGE OF THE LONG AXIS
TOUCHING THE "NON SPREADER" SLIDE AND FORMING A HINGE LIKE CONTACT BETWEEN THEM

METHOD • "SPREADER SLIDE" IS THEN ROTATED FORWARD (WHILE STILL MAINTAINING THE HINGE LIKE CONTACT)
ONTO THE DROPLET WITH GENTLE PRESSURE TO FLATTEN BUT NOT CRUSH IT

• "SPREADER SLIDE" IS THEN PULLED DOWN THE SURFACE OF THE "NON SPREADER" SLIDE (WHICH IS HELD
STEADY) TO SMEAR THE DROPLET USING CONSTANT AND GENTLE PRESSURE ON THE "SPREADER SLIDE"
WHILE CONTINUING TO MAINTAIN THE PERPENDICULAR ORIENTATION OF THE TWO SLIDES

• THE "SPREADER SLIDE" SHOULD HAVE LITTLE TO NO MATERIAL ON IT AND MAY BE DISCARDED
 • THE SLIDE WITH THE DROPLET OF FNA MATERIAL IS HELD UP SO IT IS ESSENTIALLY
PARALLEL WITH THE FLOOR BY USING THE NON DOMINANT HAND TO HOLD THE
FROSTED END PINCHED BETWEEN YOUR THUMB, INDEX AND THIRD FINGER

• A SECOND SLIDE IS THEN BROUGHT UP WITH THE DOMINANT HAND IN AN

TWO STEP
INVERTED FASHION BY GRASPING IT BY THE FROSTED END PINCHED BETWEEN
THUMB, INDEX AND THIRD FINGER

• THIS INVERTED SLIDE IS THEN POISED OVER THE SPECIMEN DROPLET OF THE SLIDE
PULL BELOW IN A PARALLEL FASHION WITH THE EDGE OF THE NON FROSTED END OF THE
INVERTED SLIDE TOUCHING JUST BELOW THE FROSTED END OF THE DROPLET SLIDE

METHOD FORMING A HINGE LIKE CONTACT

• THE INVERTED SLIDE IS THEN LOWERED (WHILE STILL MAINTAINING THE HINGE LIKE
CONTACT OF THE LOWER EDGE OF THE LONG AXIS) ONTO THE DROPLET WITH
GENTLE PRESSURE TO FLATTEN BUT NOT TO CRUSH THE DROPLET

• BOTH SLIDES ARE THEN PULLED APART TO SMEAR THE DROPLET WHILE CONTINUING
TO MAINTAIN THE PARALLEL ARRANGEMENT OF THE SLIDES USING CONSTANT AND
GENTLE PRESSURE

• BOTH SLIDE SHOULD HAVE A GOOD QUALITY OVOID SHAPE OF SMEAR MATERIAL
STAINING
• PUT THE SLIDES IN THE SLIDE CONTAINER WITH REQUIRED
MEDIUM AND TOGETHER WITH ATTACHED THE
INVESTIGATIONS ( ON THE REQUEST FORM ) SEND THE
SLIDES FOR STAINING
 ULTRASOUND GUIDED
FNAC
MANY MEDICAL SUBSPECIALISTS USE ULTRASOUND (US) FOR
EVALUATION AND INTERVENTIONAL PROCEDURES BUT PATHOLOGIST
USE IS RELATIVELY NEW.
 GENERAL

• PATHOLOGISTS WHO PERFORM FINE NEEDLE ASPIRATION (FNA) MAY USE

ULTRASOUND, AFTER PROPER TRAINING, TO

1. CONFIRM EXISTENCE OF MASS (E.G. RULE OUT PSEUDOTUMOR OR

NORMAL ANATOMY)

2. EVALUATE ASPECTS OF MASS TO ASSIST WITH PERFORMING THE FNA,

INCLUDING:
a) SIZE/MARGINS/DEPTH FROM SKIN (CAN MY NEEDLE REACH IT?)
b) SOLID/ CYSTIC /NECROTIC
c) VASCULARITY
d) RELATIONSHIP TO OTHER ANATOMICAL STRUCTURES
e) DETERMINING THE MOST SUSPICIOUS LESION (E.G. IF MULTIPLE
THYROID NODULES ARE PRESENT)
 Promotes patient care, because
WHY
PATHOLOGISTS
Improved diagnostic accuracy and value
SHOULD
PERFORM
ULTRASOUND Reduces need for more expensive, invasive, painful core
needle biopsies
GUIDED FINE
NEEDLE
Improved diagnostic value
ASPIRATION
(USFNA)
Decreases problems when pathologist is not in control of
FNA procedure
DOCUMENTATION
AND BILLING
• TO ENSURE PROPER DOCUMENTATION FOR AN FNA PROCEDURE, THE PRACTITIONER MUST
DOCUMENT ( SOFTWARE AND REGISTER ) THESE ELEMENTS IN THE MEDICAL RECORD:
• DEMOGRAPHICS INCLUDING FACILITY NAME, PATIENT NAME, DATE AND TIME OF EXAM, ETC.
• RELEVANT PATIENT CLINICAL INFORMATION
• MEDICAL NECESSITY FOR THE EXAMINATION
• WHO PERFORMED THE FNA
• BILLING SHOULD BE DONE AND THE RECEIPT COPY SHOULD BE HANDED OVER TO THE PATIENT
RELEVANT ANATOMY