Fine-needle aspiration

We do.

FNA washout fluid combined with immunocytokinistry is an excellent alternative.

How does that work practically?

If you place a needle directly into the suspicious nodule under ultrasound, wash that needle out with saline, and measure the calcitonin from that localized fluid, you convert an ambiguous systemic blood signal into a highly targeted localized one.

Are these cells bad players? We'll judge them by the company they keep.

And I know you've talked about this on the podcast before, but it's worth saying every time that an FNA is generally unhelpful in hematology.

And if you suspect there's a hematological malignancy, then starting with an FNA is just going to delay the definitive diagnosis and will make your hematologist cry.

Mm-hmm.

Yeah, and also, can I say, there's no excuse in DLBCL because the mass is usually huge, so you can 100% get a proper core bioxy.

So DLBCL is the most common aggressive lymphoma, about 35% of NHL in Australia.

It presents as a rapidly enlarging, usually painless mass, and usually with B symptoms, and a raised LDH.

To diagnose it, get a core or excisional biopsy, please no FNA, as the architecture is essential for diagnosis.

It can be a biopsy from a metastasis.

It can be a biopsy, resection, or FNA, whatever qualifies as the highest quality tumor sample.

Again, once you perform the test and it's a positive result, that patient receives HER2-target therapy.

If it's negative, sometimes it's because it's an adequate specimen or whatever reason.

And essentially, that proof that something is not cancerous does not rely on a fine needle aspirate, but relies on that tumor being in a specimen pot so it can be analyzed fully by the histopathologist.

So in principle, all parotid masses should be excised because of the inaccuracies in FNAs and core biopsies that determine whether something's cancerous or not.

And the most common parotid lump is a pleomorphic adenoma, which has a risk of becoming cancerous the longer it's left behind.

So that would be sort of my lasting advice when I think comes to prodded masses.

It's October, and I continue shining my spotlight for Breast Cancer Awareness Month.

Last week, I went over fine needle aspiration or FNA breast biopsies.

Let's go over percutaneous needle biopsies or PNB to make sure that you are understanding the code descriptions and how to compliantly code and bill for these surgical services.

So what is a PNB breast biopsy? Last week, I discussed FNA biopsies and their thinner needle usage.

But PNBs, they use a larger needle to remove a bigger tissue sample, a procedure that is more complex than an FNA and can involve the use of a local anesthetic to numb the area of the body from which the sample will be taken.

Now, providers commonly use this technique on larger bodily structures, such as the breast.

And here's a big tip.

Remember that PNBs involve more work, so payers commonly reimburse them at a higher level than our FNA breast biopsies.