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Test Code LAB5002T Fine Needle Aspiration Biopsy, Thyroid Only

Specimen Requirements

Thyroid FNA’s do not need direct smear preparation.Most of the medical literature shows that there are fewer unsatisfactory specimens and fewer indeterminate specimens when processing thyroid aspirates using a liquid based preparation technique instead of smears. It allows for a uniform method of sample collection while also saving time and materials during the procedure.

Other solid lesion FNA’s DO require air dried and alcohol fixed pull smear preparation during collection in addition to needle rinses in CytoLyt. See Fine Needle Aspiration Neck, Lymph Node, Parotid, Salivary, and Miscellaneous for collection information.

Afirma Genomic Sequencing/Molecular testing can be performed as a reflex test on Thyroid FNA’s, dependent on Cytology results. If ordered and collected, Afirma will be done on indeterminate results (Category III and IV) for additional information that may be helpful for patient management and follow-up. Afirma will bill separately for this test. Patient pre-authorization is not required. Contact Afirma for potential costs (see page 2).

See collection instructions to obtain supplies in advance of the procedure.

Materials:
1. PPE including eye protection for blood and body fluid splashes
2. Light blue top CytoLyt cup(s), 30 ml volume
3. 1 ml Veracyte vial (optional).
4. Veracyte vial must be received in lab and frozen within 24 hours of collection.
5. Thyroid FNA information form – for non-EPIC locations
6. FNA Order (include Afirma as appropriate) authorized by the physician/radiologist
7. Patient clinical history - Non-EPIC locations
8. Patient demographics and insurance information - Non-EPIC locations
9. 10 cc syringes or as appropriate
10. 25 gauge needles or as appropriate
11. Specimen collection supplies (2-6 above) are provided by BAH Cytology, 541-269-8454

Specimen Transport.

CytoLyt and Veracyte containers are transported ambient, but Veracyte vials must be frozen at -80°C within 24 hours of collection. Place labeled specimen tube inside a biohazard bag with the request form in the outside pocket of the bag. Transport specimen to laboratory within 4 hours of collection. If specimens are sent late in the day with the Veracyte vial they should not be sent later in the day on Fridays and before holidays.

Unacceptable Criteria
Specimens submitted in formalin.
Unlabeled specimens.

Stability:

Temperature Time
CytoLyt and Veracyte Room Temp 18-28°C 4 hours
CytoLyt and Veracyte Refrigerated 2–8°C 24 hours
Veracyte not frozen at -80°C within 24 hours of collect Not acceptable
CytoLyt Frozen <0°C Not acceptable

Collection Instructions

1. Follow standard aseptic collection procedures.
2. Separate containers must be used for multiple sites sampled.
3. Obtain syringe and needle of each pass from Radiologist/physician by contactless transfer.
4. Ideally, there should be 0.1 to 0.25 ml material in the syringe for each pass. This equates to material visible past the hub of the needle, extending into the syringe housing.
5. Rinse material from each pass into the CytoLyt.
6. To rinse the syringe housing, hub, and needle; unscrew needle from syringe, pull 1-2 ml CytoLyt into syringe.
7. Replace needle to syringe, rinse material into CytoLyt.
8. This may need to be done twice to remove most of blood and cell sample from hub.
9. Discard needle in Sharps.
10. Repeat steps 1-8 for each pass.
11. If Afirma is ordered, gently express last pass (2-3 drops) into the Veracyte vial, then rinse needle, hub and syringe in CytoLyt.
12. Clots should not develop, as CytoLyt has a hemolytic agent, but if a clot develops in the needle, try to pull some CytoLyt into the needle to rinse out clot. You can also try to gently push some CytoLyt through the needle after pulling some into the syringe and securely reattaching the needle to the syringe. Avoid too much pressure to prevent leakage or splash from screw hub of needle.
13. Once 3 passes are made, inspect CytoLyt cup for particulate matter and blood fragments. Additional passes may be needed if there are not visible flecks, fragments, clots and blood in the cup.
14. Cystic fluid may exceed bloody cellular aspirate amounts. Cystic material should also be aspirated in the CytoLyt vial. Use an additional CytoLyt cup if cystic fluid amount exceeds 5 ml. Separate the cystic fluid from any subsequent more solid material in a separate CytoLyt cup.
15. Complete thyroid pass form or in EPIC the location of nodule(s), nodule consistency on palpation and needle aspiration, other pertinent history, imaging results.
16. Specific areas of thyroid sampled (left medial, isthmus, right superior) are required.
17. Non-EPIC locations: Complete FNA order with providers to copy, location of aspirated nodules. Submit paperwork including history as appropriate, FNA order and FNA pass form
18. Place samples in biohazard bag with appropriate paperwork.
19. The lab will triage for Afirma testing, based on the cytology results.

Additional Information

1. Report provides interpretation.
2. For non-EPIC providers, results are faxed to the locations/providers.
3. Cytology results TAT: 2-3 days, performed M-F 8:00-16:30
4. The Bethesda System Classification is used for Thyroid Cytopathology Reporting at BAH (Category I-VI).
5. If Afirma is ordered per reflex protocol, the lab will triage for Afirma testing, based on the cytology results (Category III and IV). It will be indicated on the original report.
6. Afirma results TAT is 2-3 weeks. Results are scanned into the cytology interpretive report in EPIC as an addendum, and faxed directly to Non-EPIC providers.
7. Questions on results and reporting can be directed to the pathologists @ 541-269-8453, or the cytotechnologist @ 541-269-8458

Test Limitation
Abnormal results must be correlated with history and other test results.

References
1. Hologic Corporation
1. The Bethesda System for Reporting Thyroid Cytology
2. Afirma; www.afirma.com ; email: support@veracyte.com; 888-923-4762

Synonyms

FNA, Fine Needle Aspirate, LAB5002, Thyroid, Cytology

Department

Cytology