Building a Center of Excellence in Hematopathology: Review of CNB and FNA Samples To Improve the Current Workflow
Karyn De Souza, Lisa Duncan, John Snidow, Yorke Young, Laurentia Nodit. University of Tennessee Medical Center, Knoxville, TN
Background: Increased clinical demand to diagnose lymphoma from core needle biopsy(CNB) and fine needle aspiration(FNA) samples requires collaboration between radiologists, cyto- and hematopathologists to ensure collection of adequate sample and triage for ancillary studies. No criteria for adequacy are available and the sequence for best tissue retrieval and workflow is not well defined. As part of our performance improvement, we reviewed our work to identify quality gaps and points of intervention to increase the diagnostic accuracy of lymphoma.
Design: Review of 2010-2011 electronic data identified 108 CNB and FNA samples for involvement by lymphoma. Excluded from this study were bone marrow biopsies and metastatic carcinomas; included were samples from superficial and deep seated masses/organ lesions. When available, we reviewed pathology and radiology reports for history, location, quantity of sample collected, flow cytometry, accuracy of correlation between intraoperative cytology interpretation and final diagnosis and/or follow-up resections. Findings were assessed by our radiologists, cyto- and hematopathologists to develop/apply an improvement plan.
Results: 24% of cases had prior history of lymphoma; others were from patients with lymphadenopathy. Most samples were superficial (65%) and the number of cores varied (3-multiple). The needle gauge used was 19-20. In 47 cases, flow samples collected as CNB were diagnostic in 31%. Out of 61 flow samples collected as FNA, 67% were diagnostic. The diagnosis was established in 93/108 cases (86%) and 5/15 nondiagnostic samples had lymphoma on surgical follow-up. Intraoperative consultation by cytopathologists was performed in 104/108 cases and correlated with final diagnosis in 72% cases.
Conclusions: As a result of this review, we built a new requisition for clinical history documentation of lymphoma and CBC. Marked difference in flow-cytometry results where FNA rather than core biopsies were submitted required a new lymphoma biopsy protocol in Radiology. Flow cytometry samples by FNA will be collected first, followed by a CNB using a larger needle gauge(18). In Cytology, verification for adequacy on flow sample in addition to core biopsy touch preps was implemented, and a transfer policy of cases between cyto- and hematopathology staff was created. In Histology, separating core biopsies in 2 blocks was done to secure more tissue for ancillary studies. The effect of the implemented measures will be assessed early January 2012.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 263, Monday Afternoon