Ultrasound Guided Fine Needle Aspiration (USFNA)

Topic Completed: 1 March 2013

Revised: 3 January 2019, last major update March 2013

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

PubMed Search: Ultrasound guided fine needle aspiration [title] review[ptyp]

Joseph D. Jakowski, M.D.
Susan Meanor, R.T., R.D.M.S.
Page views in 2019: 108
Page views in 2020 to date: 23
Cite this page: Jakowski J. D., Meanor S. General. website. Accessed May 26th, 2020.
Definition / general
  • Many medical subspecialists use ultrasound (US) for evaluation and interventional procedures but pathologist use is relatively new
  • Pathologists who perform fine needle aspiration (FNA) may use US, after proper training, to (a) confirm existence of mass (e.g. rule out pseudotumor or normal anatomy) and (b) evaluate aspects of mass to assist with performing the FNA, including:
    • Size
    • Margins (well circumscribed versus irregular / infiltrative)
    • Depth from skin (can my needle reach it?)
    • Solid versus cystic or necrotic
    • Vascularity
    • Relationship to other anatomical structures
    • Determining the most suspicious lesion to needle (e.g. if multiple thyroid nodules are present, Cancer 2008;114:463)
Why pathologists should perform Ultrasound Guided Fine Needle Aspiration (USFNA)
  • Promotes patient care, because (a) diagnostic accuracy increases and unsatisfactory rate decreases when a well trained pathologist performs the FNA and interprets the diagnostic material, compared to FNAs performed by nonpathologists; (b) reduces need for more expensive, invasive, painful core needle biopsies (Diagn Cytopathol 2009;37:262); (c) improved diagnostic value (Diagn Cytopathol 2011;39:743); (d) decreases problems when pathologist is not in control of FNA procedure:
    • Improper sample triage (e.g. need for unstained smears, cell block, RPMI for flow cytometry, sending sample for PTH or thyroglobulin levels or for culture, Diagn Cytopathol 2010;38:327)
    • Insufficient acquisition of material for ancillary studies (e.g. FISH and flow cytometry)
    • Decreased direct communication with patients and referring physicians
  • Satisfies demand from referring clinicians for USFNA of palpable and nonpalpable masses (e.g. thyroid nodules) not being met by other medical subspecialists (e.g. radiologists or endocrinologists)
  • Helps maintain or increase number of pathologist FNAs performed (palpation guided FNAs are decreasing and USFNA are increasing)
  • Supports pathologist income stream due to recent availability of lower cost, high quality US machines for purchase
  • Increases pathologist training and educational opportunities in US medicine and USFNA
  • Preferable to time consuming process and low levels of reimbursement for pathologists who provide rapid onsite evaluation for other physicians who are performing USFNA
  • Many pathologists want to increase their scope of practice to FNA of nonpalpable superficial masses by using US (Diagn Cytopathol 2008;36:317)
  • Enables pathologists to keep up with and embrace the latest technologies in medicine
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