FNA Cytology of the Liver Wendy Blount, DVM Free PowerPoint Templates

Triplett – Fisher Scientific Patient & Equipment Preparation Pre-Sampling Lab work CBC confirming platelets >50,000/ul within 24 hrs (Buccal Mucosal Bleeding Time (BMBT) <2 minutes Triplett – Fisher Scientific Jorvet - Surgicutt Free PowerPoint Templates

Patient & Equipment Preparation Pre-Sampling Lab work CBC confirming platelets >50,000/ul within 24 hrs (Buccal Mucosal Bleeding Time (BMBT) <2 minutes Lift the upper lip (gauze muzzle) Remove the device safety tab Place the device on the mucosa Push the device trigger button Dab dripping blood every 15 seconds, but don’t touch the clot 6. BMBT = when bleeding stops Free PowerPoint Templates

Patient & Equipment Preparation Pre-Sampling Lab work CBC confirming platelets >50,000/ul within 24 hrs (Buccal Mucosal Bleeding Time (BMBT) <2 minutes If liver disease, PT/PTT Any preanesthetic lab work or other diagnostics indicated for safe anesthesia Free PowerPoint Templates

Tips for US Guided FNA/Biopsy Choose the shortest direct path between skin and the target Try not to pass through more than one body cavity, and not more than one organ Separate needle for each location Indirect guidance – use US to find a good place, and then do a blind needle pass Draping usually not necessary Stab incision needed for core biopsy, but not FNA Free PowerPoint Templates

FNA vs. Core Biopsy FNA probably better for vascular areas Core biopsy for large solid lesions Check your FNA cytology, and if non-diagnostic, consider a core Sacrifice a core biopsy for cytology to make sure you have a good sample Free PowerPoint Templates

FNA vs. Core Biopsy FNA probably better for vascular areas Core biopsy for large solid lesions Check your FNA cytology, and if non-diagnostic, consider a core Sacrifice a core biopsy for cytology to make sure you have a good sample Needle throw length Free PowerPoint Templates

Tips for FNA Try a “core” FNA first with no attached syringe Less hemodilution Attach air filled 10cc syringe and propel needle contents onto a slide Prep, dry and stain as usual Free PowerPoint Templates

Tips for FNA Try a “core” FNA first with no attached syringe Less hemodilution If that fails, add aspiration with syringe 2cc saline in syringe for better recovery on firm lesions that produce scant samples Spin down & prep slides from sediment Free PowerPoint Templates

Tips for FNA Try a “core” FNA first with no attached syringe Less hemodilution If that fails, add aspiration with syringe 2cc saline in syringe for better recovery on firm samples that produce scant samples Spin down & prep slides from sediment If that fails try a core biopsy under deep sedation Free PowerPoint Templates

FNA/Biopsy of Liver Difficult to impossible in deep chested dogs with small livers Use the ultrasound to avoid pleural cavity when using intercostal approach Liver biopsy/FNA for diffuse disease – left lobes Use US to avoid GB and vessels Penetrate through the capsule before deploying the Trucut to minimize bleeding Free PowerPoint Templates

FNA/Biopsy of Liver Indirect Ultrasound Guidance Notch between xyphoid and costal arch Choose needle length sufficient to penetrate falciform ligament (at least 1-1/2“) Check for liver presence with the US probe Clip & surgically prep the area Penetrate the skin and pause Pass needle to the hub into the liver Direct needle 45o to table, toward head Do not redirect – straight in, straight out Core first, then add aspiration if needed X Free PowerPoint Templates

FNA/Biopsy of Liver Indirect Ultrasound Guidance Notch between xyphoid and costal arch Choose needle length sufficient to penetrate falciform ligament (at least 1-1/2“) *Quickly* squirt needle contents onto a slide Prep, dry and stain as usual Confirm that you have hepatocytes on the slide Big purple cells – granular cytoplasm Free PowerPoint Templates

FNA/Biopsy of Spleen Very low risk of bleeding for diffuse disease and solid tumors Significant hemorrhage risk for cystic structures Indirect ultrasound guidance often sufficient for diffuse disease Free PowerPoint Templates

FNA & Biopsy Complications Bleeding – watch for this with the US probe for 5 minutes after last stick (<1% hemorrhage risk) If bleeding is a concern, stick to a smaller needle Use Doppler to identify and avoid large vessels Small amount of self limiting bleeding is no problem (5%) Asymptomatic pneumothorax after lung FNA no problem Rupture of fluid filled structure Gall bladder – bile peritonitis Free PowerPoint Templates

Summary PowerPoint – 1 slide/page, 6 slides/page Dry Lab Handout – Fine Needle Aspiration of the Liver Hidden slide – list of materials

Thomas Nyland, John Mattoon, Eric Herrgesell, Erik Wisner Acknowledgments Robert Fulton Chapter 8: Focused or COAST3 – Reproductive Focused Ultrasound Techniques for the Small Animal Practitioner Editor Greg Lisciandro Thomas Nyland, John Mattoon, Eric Herrgesell, Erik Wisner Chapter 3: Ultrasound Guided Biopsy Small Animal Diagnostic Ultrasound Editors Nyland and Mattoon – 3rd Edition 2014