1. FNA Cytology of the Liver
Wendy Blount, DVM
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2. 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
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3. 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
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4. 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
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5. 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
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6. 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
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7. 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
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8. 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
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9. 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
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10. 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
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11. 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
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12. 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
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13. 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
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14. 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
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15. 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
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16. Summary PowerPoint – 1 slide/page, 6 slides/page
Dry Lab Handout – Fine Needle Aspiration of the Liver
Hidden slide – list of materials

17. 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