Cytopathology and Fine-Needle Aspiration (FNA) Biopsy

The Houston Methodist Department of Pathology and Genomic Medicine’s Cytopathology Section has 16 dual board-certified (Anatomic Pathology and Cytopathology) faculty members who provide comprehensive diagnostic services. The team processes and analyzes over 35,000 clinical cytology specimens annually. These include over 20,000 gynecologic and 12,000 non-gynecologic specimens, and approximately 3,600 fine-needle aspiration (FNA) samples. Cytopathologists are available for rapid on-site adequacy assessments and work closely with interventional radiologists, pulmonologists, and gastroenterologists. The two trainees in the ACGME-approved Cytopathology Fellowship Training Program are in high demand for adequacy assessments and fine-needle aspiration services, done in conjunction with cytopathology faculty. The cytopathology laboratory is accredited by the College of American Pathologists.

Gynecologic cytology:
All gynecologic cytology services are provided by board-certified cytopathologists. The following gynecologic cytology and tissue services are available:
  • Conventional pap smears, ThinPrep pap tests
  • High-risk HPV testing, chlamydia and gonorrhea testing from vial
  • Interpretation of tissue biopsies with cytologic-histologic correlation
  • Microbiology cultures, vaginosis panels, and other tests

Non-gynecologic/exfoliative cytology interpretation services:
  • Respiratory cytology (sputum, bronchial wash, bronchial brush, bronchoalveolar lavage)
  • Urinary cytology (voided urine, bladder washings, and other urinary tract samples)
  • Gastrointestinal and pancreatobiliary tract cytology (brushing and washings)
  • Tzank smears
  • Body fluids (pleural, peritoneal, and pericardial effusions, vitreous and aqueous fluids, CSF, pelvic wash)
  • Other body sites

Fine-needle aspiration (FNA):
  • FNA biopsies of superficial, easily palpable masses: performance, adequacy assessment, and final interpretation with ancillary studies as needed
  • Abdominal fat pad aspiration for detection of amyloid: performance of aspiration and interpretation
  • Adequacy evaluation and interpretation of FNA and core needle biopsies from all sites (includes image-guided, endoscopic ultrasound-guided, and endobronchial ultrasound-guided procedures)
  • Correlation with concurrent core needle biopsy, if applicable

FNA procedure and scheduling:
The FNA procedure provides immediate evaluation for adequacy and triage and a final diagnosis within 24 hours in over 90% of patients. The procedure is performed in the Houston Methodist Outpatient Center (OPC) by board-certified cytopathologists. We aim to provide rapid diagnosis of lesions enabling our colleagues to plan for definitive therapy, ideally without the need for a more invasive type of biopsy. We have limited our practice to palpable lesions (including thyroid nodules, salivary glands, breast, lymph nodes, soft tissue, and other superficial masses). Abdominal fat pad aspiration for diagnosis of amyloid is also performed either in the FNA clinic on OPC 17 or by the bedside. Deep lesions and non-palpable superficial lesions requiring radiologic localization are performed by the Radiology Department at Houston Methodist Hospital.

The procedure is performed by a board-certified cytopathologist and a cytopathology fellow. After the lesion has been biopsied, a portion is analyzed immediately to ensure that enough tissue has been obtained for diagnosis and any necessary ancillary studies. The procedure is simple and takes about 20 minutes. The total time in the clinic is approximately 45 to 60 minutes. For inpatients, the procedure can be performed at the bedside. Same day appointments are usually available and every effort is made to accommodate the needs of out-of-town patients.

To schedule:
Call 713-441-1447 between 8:00 AM and 5:00 PM, or fax a physician order to 713-441-1477. Pathologist-performed superficial FNA biopsies and fat pad aspirations for amyloid can be ordered in EPIC, but, the above number still needs to be called between 8:00 AM and 5:00 PM. The exact location of the lesion to be aspirated, clinical history, and any other pertinent data are very helpful and should be written on the physician order. Cytopathologists and/or cytopathology fellows are readily available to answer any questions referring physicians or patients may have. Patients may eat or take any normal medications prior to the procedure. Please indicate if the patient is on anticoagulants or has a coagulopathy. We prefer that patients not be on anticoagulants, but this is not always an absolute contraindication for performing the procedure. FNA procedures can also be performed on inpatients in their hospital rooms at Houston Methodist Hospital in the Texas Medical Center location.

Clinic location:
The Pathology FNA clinic is located inside Radiology Outpatient Services, on the 17th floor of the Methodist OPC, 6445 Main St., Houston, TX, 77030. Patient registration is available onsite, or you may call 713-394-6805. Patient parking is available at the Houston Methodist OPC.