Palpation guided fine needle aspiration

Topic Completed: 1 August 2013

Revised: 3 January 2019, last major update August 2013

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Palpation guided fine needle aspiration

Joseph D. Jakowski, M.D.
Page views in 2019: 212
Page views in 2020 to date: 43
Cite this page: Jakowski J. D. PGFNA general. website. Accessed May 26th, 2020.
Fine needle aspiration definitions
  • Fine Needle Aspiration (FNA) Biopsy: Using a "fine needle" to remove a sample of cells from a target mass or lesion for diagnostic purposes
  • Fine needle: Defined as a 22 gauge or smaller diameter needle (e.g. 23, 25, 27 gauge)
  • FNA target: A lump or bump (e.g. in thyroid, breast, soft tissue, or enlarged lymph node) that is clinically suspicious and whose diagnosis will affect patient management
    • FNA is not for every minor swelling or abnormality
    • Ill defined indurations, clinically insignificant lymph nodes, and vague inflammatory conditions are poor FNA targets
  • FNA for therapeutic purposes: cysts and abscesses may be drained and decompressed by FNA, which may alleviate symptoms and provide material for diagnosis or culture
History of fine needle aspiration
  • Current acceptance of Fine Needle Aspiration (FNA) in medicine as a safe, cost effective, and accurate procedure for diagnosis has historically followed a similar course to the development of other important medical procedures
  • Much speculation has been made as to the reasons why FNA had an initial lack of acceptance in major hospitals in the United States in the mid 20th century when the European medical community, in particular Sweden, embraced and perfected this technique during this same period
  • Explanations for lack of initial success of FNA in US before 1970's:
    • Initial failure of pathologists to effectively communicate virtues of FNA; focus on expounding exfoliative cytology (i.e. post Papanicolaou era)
    • Opposition to and negative conclusions about FNA based on rare cases of needle tract seeding of tumors by "large bore" FNA needles (e.g. 18 gauge) as reported by influential physicians like Ochsner, DeBakey, and Crile in 1940's and 1950's
    • Lack of familiarity with FNA technique and its value in tumor diagnosis by non pathologists (surgeons) and their preference for surgical biopsies
    • Lack of a practicing "clinical cytologist" and hybrid physicians, as in the Swedish model, where the same physician seeing the patient performs the FNA and interprets the cytology

  • Chronologic overview of the major events, publications, and various contributors that have aided in the development and success of FNA as we know it today: (note: authors acknowledge incomplete nature of this list, and that others have contributed to advancement and success of FNA and aspiration cytology):

      c. 1000
    • First description of therapeutic needle puncture (of the thyroid): by Arabian physician Albucasis

    • Puncture aspiration for diagnosis of echinococcus cyst, simultaneous reports by Dupuytren and Stanley

    • Hollow needle invented by Irish physician Francis Rynd

    • First report of an attempt to diagnose a tumor with the use of a needle, by Kün

    • First practical syringe, developed by French physician Charles Gabriel Paraz
    • Needle biopsy for diagnosis of breast tumors, by Sir James Paget and Erichsen

    • Needle aspiration biopsy for diagnosis of tumors and cutaneous lymphomas, by German hematologist Hans Hirschfeld

    • Guthrie at John Hopkins reports needle aspiration success (21 gauge) in diagnosing syphilis and tuberculosis, as well as lymphoma, leukemia and metastatic carcinoma

    • 18 gauge needles are used for needle aspiration biopsy with much success at Memorial Hospital in New York City, USA, by surgeons Bradley Coley and Hayes Martin

    • First to scientifically establish the technique of needle biopsy, British pathologist Leonard Dudgeon

    • Head and neck surgeon, Hayes Martin, and chief technologist, Edward Eillis, at Memorial Hospital (New York City, USA) publish landmark paper on needle aspiration biopsy using 18 gauge needles
    • Reports on the needle diagnosis of prostate tumors, Ferguson

    • First report on technique of FINE needle aspiration biopsy (1 mm size needle), German pathologist Ernst Mannheim

    • Monumental paper by pathologist Fred Stewart on interpreting 2500 aspirates from surgeons Bradley Coley and Hayes Martin from Memorial Hospital in New York City, USA

    • Martin and Ellis publish second landmark paper on needle aspiration biopsy

    • Martin and Stewart publish "The advantages and limitations of aspiration biopsy"

    • Air dried needle aspiration slides stained with Romanowsky type stains, by hematologist Lopez-Cardozo and internist Soderstrom

    • Invention of pistol grip handle to facilitate FNA and a biopsy needle and guide for transrectal prostate aspirations, Dr. Sixten Franzen of Sweden

    • American Society of Cytopathology founded

    • "Clinical Cytology", by Dr. Paul Lopes-Cardozo of Holland

    • The International Academy of Cytology founded
    • Acta Cytologica founded by Dr. George L. Wied of University of Chicago, USA

    • "Identification of normal tissues and tumors by cytologic aspiration biopsy"m by Dr. Nils Söderström of Sweden

    • "Diagnostic Cytology and Its Histopathologic Bases", by Dr. Leopold Koss

    • "Fine Needle Aspiration Biopsy", by Dr. Nils Söderström of Sweden

    • "Elementos de Citologia Clinica", by Dr. Pedro Paseyro of Uruguay

    • "Monographs in Clinical Cytology. Volume 4. Aspiration biopsy Cytology: Part I: Cytology of supradiaphragmatic organs", by Dr. Josef Zajicek of the Karolinska Institute in Sweden

    • "Monographs in Clinical Cytology. Volume 4. Aspiration biopsy Cytology: Part I: Cytology of infradiaphragmatic organs", by Dr. Josef Zajicek of the Karolinska Institute in Sweden
    • The American Society for Cytotechnology founded

    • "Thin Needle Aspiration Biopsy", by Dr. William Frable of Medical College of Virginia, USA

    • "Smearing techniques for the concentration of particles from fine needle aspiration biopsy", by Drs. John S. Abele, Theodore R. Miller, Eileen B. King, and Torsten Lowhagen
    • Diagnostic Cytopathology journal founded by John Wiley & Sons, Editor Dr. Carlos W.M. Bedrossian

    • Zajdela's needle only FNA technique: "Cytologic diagnosis of orbital and periorbital palpable tumors using fine needle sampling without aspiration", by Dr. Antoine Zajdela et al at the Institute Curie of France

    • Cameco Syringe Pisto invented by Sven A. Swallert of Sweden, Cameco Medical Limited

    • "Clinical aspiration cytology" published by Drs. Joseph Linsk and Sixten Franzen

    • "Clinical Cytopathology & Aspiration Biopsy", by Dr. Ibrahim Ramsy of Baylor College of Medicine, USA
    • Cytopathology journal founed by John Wiley & Sons

    • "Fine Needle Aspiration of Palpable Masses", by Drs. Micheal Stanley and Torsten Lowhagen

    • "Pediatric Cytopathology", by Drs. Kim R. Geisinger, Paul E. Wakely, and Jan F. Silverman, USA

    • "Cytology: Diagnostic Principles and Clinical Correlates", by Drs. Edmund Cibas and Barbara S. Ducatman, USA
    • "Art and Science of Cytopathology", by Dr. Richard DeMay of University of Chicago, USA
    • National Cancer Institute Consensus Development Conference on Breast Fine Needle Aspiration, Bethesda, Md

    • Cancer Cytopathology journal founded by American Cancer Society, Editor Dr. William J. Frable of the Medical College of Virginia, USA
    • Guidelines of the Papanicolaou Society of Cytopathology for fine needle aspiration procedure and reporting. The Papanicolaou Society of Cytopathology Task Force on Standards of Practice (Diagn Cytopathol 1997;17:239)

    • Papanicolaou Society of Cytopathology founded

    • The National Cancer Institute Thyroid fine needle aspiration state of the science conference, Bethesda Maryland, USA
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