Quality control of fine needle biopsy cytology of lymph node, especially for improvement of inadequate specimen rate

Objectives : We studied quality control for improving cellular specimen adequacy in lymph-node fine-needle biopsy (FNB). Study Design : Subjects numbered 1,850 cases, i. e., 1,691 from 2002 to 2007 at site 1 and 159 from 2005 to 2007 years at site 2, with FNB as shown in Figure 1 as follows : 1. A cart with a FNB needle, glass specimen slide, fixative, Diff-Quik staining material, and a microscope were taken to the examination site by a physician and a technologist. 2. At site 1, Echo-guided FNB lymph node aspiration conducted by inserting a 24 G needle, turning it without aspiration, withdrowing it, attaching it to a syringe, then extruding the cellular specimen onto the specimen slide. 3. The smear was made by pressing a second specimen slide onto the specimen on the first slide. 4. Sampling was confirmed using the microscope immediately after Diff-Quik staining. 5. Diff-Quik and with Papanicolaou staining have been used to improve cytodiagnostic precision. At site 2, echo-guided FNB with aspiration cytology was conducted using a “pistol” attached to a syringe (20 ml) with a 22 G needle. The cellular sample smear was made and immediately fixed in 95% ethanol, then stained by the Papanicolaou method in the laboratory. Results : The annual average specimen inadequacy at site 1 from 2002 to 2004 was 9.6%, and 3.8% from 2005 to 2007, versus an annual average of 3.1% at site 2. Conclusions : Annual average specimen inadequacy in echo-guided lymph-node FNB was less than 5%. A needle must hit a lesion under ultrasonography to improve specimen adequacy, and physicians must be trained sufficiently in echo-guided FNB cytology. The physician-cytotechnologist team is thus desirable in planning effectiveness for the puncture site and stable specimen adequacy.