Cytopathology
Palpation guided fine needle aspiration
General

Author: Joe D. Jakowski, M.D. (see Authors page)

Revised: 8 February 2018, last major update August 2013

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

PubMed Search: Palpation guided fine needle aspiration

Cite this page: Jakowski, J. D. PGFNA general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cytopathologypgfnageneral.html. Accessed August 14th, 2018.
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

      1833
    • Puncture aspiration for diagnosis of echinococcus cyst, simultaneous reports by Dupuytren and Stanley

      1844
    • Hollow needle invented by Irish physician Francis Rynd

      1846
    • First report of an attempt to diagnose a tumor with the use of a needle, by Kün

      1853
    • First practical syringe, developed by French physician Charles Gabriel Paraz
    • Needle biopsy for diagnosis of breast tumors, by Sir James Paget and Erichsen

      1912
    • Needle aspiration biopsy for diagnosis of tumors and cutaneous lymphomas, by German hematologist Hans Hirschfeld

      1921
    • Guthrie at John Hopkins reports needle aspiration success (21 gauge) in diagnosing syphilis and tuberculosis, as well as lymphoma, leukemia and metastatic carcinoma

      1925
    • 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

      1927
    • First to scientifically establish the technique of needle biopsy, British pathologist Leonard Dudgeon

      1930
    • 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

      1931
    • First report on technique of FINE needle aspiration biopsy (1 mm size needle), German pathologist Ernst Mannheim

      1933
    • 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

      1934
    • Martin and Ellis publish second landmark paper on needle aspiration biopsy

      1936
    • Martin and Stewart publish "The advantages and limitations of aspiration biopsy"

      1940
    • Air dried needle aspiration slides stained with Romanowsky type stains, by hematologist Lopez-Cardozo and internist Soderstrom

      1950's
    • Invention of pistol grip handle to facilitate FNA and a biopsy needle and guide for transrectal prostate aspirations, Dr. Sixten Franzen of Sweden

      1951
    • American Society of Cytopathology founded

      1954
    • "Clinical Cytology", by Dr. Paul Lopes-Cardozo of Holland

      1957
    • The International Academy of Cytology founded
    • Acta Cytologica founded by Dr. George L. Wied of University of Chicago, USA

      1958
    • "Identification of normal tissues and tumors by cytologic aspiration biopsy"m by Dr. Nils Söderström of Sweden

      1961
    • "Diagnostic Cytology and Its Histopathologic Bases", by Dr. Leopold Koss

      1966
    • "Fine Needle Aspiration Biopsy", by Dr. Nils Söderström of Sweden

      1970
    • "Elementos de Citologia Clinica", by Dr. Pedro Paseyro of Uruguay

      1974
    • "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

      1979
    • "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

      1983
    • "Thin Needle Aspiration Biopsy", by Dr. William Frable of Medical College of Virginia, USA

      1985
    • "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

      1986
    • 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

      1987
    • Cameco Syringe Pisto invented by Sven A. Swallert of Sweden, Cameco Medical Limited

      1989
    • "Clinical aspiration cytology" published by Drs. Joseph Linsk and Sixten Franzen

      1990
    • "Clinical Cytopathology & Aspiration Biopsy", by Dr. Ibrahim Ramsy of Baylor College of Medicine, USA
    • Cytopathology journal founed by John Wiley & Sons

      1993
    • "Fine Needle Aspiration of Palpable Masses", by Drs. Micheal Stanley and Torsten Lowhagen

      1995
    • "Pediatric Cytopathology", by Drs. Kim R. Geisinger, Paul E. Wakely, and Jan F. Silverman, USA

      1996
    • "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

      1997
    • 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)

      2003
    • Papanicolaou Society of Cytopathology founded

      2007
    • The National Cancer Institute Thyroid fine needle aspiration state of the science conference, Bethesda Maryland, USA