Ultrasound Guided Fine Needle Aspiration (USFNA)
Similarities and Differences between USFNA and Traditional Palpation Guided Fine Needle Aspiration (PGFNA)

Topic Completed: 1 March 2013

Revised: 3 January 2019, last major update March 2013

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

PubMed Search: Fine needle aspiration ultrasound palpation guided [title]

Joseph D. Jakowski, M.D.
Susan Meanor, R.T., R.D.M.S.
Page views in 2019: 60
Page views in 2020 to date: 18
Cite this page: Jakowski J. D., Meanor S. Similarities and Differences between USFNA and Traditional Palpation Guided Fine Needle Aspiration (PGFNA). website. Accessed June 1st, 2020.
Definition / general
  • Needle placement and aspiration techniques used for PGFNA are completely transferable to USFNA; being proficient in PGFNA will make the transition to USFNA much easier
  • There is loss of tactile sense of the target mass during USFNA as you are holding the US transducer to visualize the mass as opposed to PGFNA, where you immobilize the mass with your fingers
The performance of USFNA additionally requires
  • More hand-eye and fine motor coordination
    • Your eyes are focusing on the US display screen to visualize the biopsy needle as your hand directs the needle into the target mass
    • Millimeters of movement during an USFNA may be the difference in successfully visualizing your needle or not within a target

  • Involves additional thought and understanding of spatial relationships which includes:
    • Orientation of US transducer with US display screen and patient (e.g. right versus left and cranial versus caudal), AND
    • Orientation of biopsy needle within transducer's US beam (parallel versus perpendicular)

  • Nonpalpable targets can usually be easily visualized and biopsied using USFNA, but are almost never biopsied by PGFNA

  • USFNA may be more time consuming than PGFNA:
    • Increased time to obtain and review previous patient radiographic images or reports for comparison; also pre-USFNA preparation
    • Consulting with referring clinicians regarding specific biopsy targets etc.
    • US imaging and evaluation of the target mass for USFNA
    • Documenting the US findings in the cytology report and storing US images

  • USFNA requires a much larger monetary and training investment than PGFNA:
    • USFNA certification course and US Medicine CME > $3,000 USD
    • US machine and supplies > $30,000 - 40,000 USD

  • A final difference includes the possible need of some assistance during USFNA (e.g. nurse, cytotechnologist, or ultrasonographer) depending on complexity of USFNA biopsies or US evaluations performed whereas PGFNA can easily be performed by a solo pathologist
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