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FNA outpatient service offered at East Cooper  by Cindy Abole Public Relations Lowcountry patients now have a quick, cost-effective and accurate alternative to checking a suspicious lump or spot on their body allowing them to jump start their treatment if the diagnosis is serious or just gain some peace of mind.  Last November, the Department of Pathology and Laboratory Medicine opened its Fine Needle Aspiration (FNA) service at its offices in Mount Pleasant. As the state’s first free-standing clinic of its kind and possibly one of a few dozen operating in the country, the FNA Clinic provides a level of quality and expertise that’s comparable to none. The effort distinguishes the roles of the pathologist and other team members who perform this valuable service in a timely and efficient manner. Although there are several pathologists in the Lowcountry community, not all are trained at performing the FNA procedure. Located at the pathology clinic at the East Cooper Medical Arts Building, trained and certified staff is available to evaluate suspect lumps, masses and nodules by appointment. The service is open to all patients, regardless of physician referrals.  “FNA is an efficient way to make a diagnosis that’s both rapid and fairly pain-free,” said Rana S. Hoda, M.D., associate professor of pathology and laboratory medicine and director of cytopathology. “It allows patients to be seen immediately and be guided in their next step in treatment.”  A board-certified cytopathologist and FNA biopsy specialist, Hoda has performed thousands of FNAs since 1994. She joined MUSC in 2000 following previous work at Cornell’s New York Hospital and specialty fellowship training at Montefiore Medical Center and Memorial Sloan-Kettering Cancer Center in New York City.  The procedure is used to detect the cancer or cancer recurrence in tumors and metastatic disease. Cancer of the breast, thyroid and salivary glands, lymph nodes, colon and other leukemias and lymphomas can be identified using FNA. In a world where accuracy and timeliness is essential, the FNA biopsy boasts a 95 percent diagnostic accuracy rate.  The procedure involves a skilled physician using a tiny, ultra-thin needle with a syringe to remove a small sample of tissue or cells from a suspected area for more careful examination under the microscope. It is a quick and reliable technique taking only from three to four minutes that does not require anesthesia and has no scarring. Results from this technique can be determined in just 20 minutes and finalized within 24 hours. Unlike surgery, a patient can eat, take their prescribed medications and drive away following an FNA appointment and resume normal daily activities. “We’re always working in the best interest of patients,” Hoda said, citing the importance of providing the service in a comfortable, patient-friendly environment. “It is our desire to provide FNA services for the entire Charleston community. It’s part of our department's and MUSC’s efforts to find ways to better serve the Lowcountry, medically.”  Typically, patients with a suspicious lump would arrange for a visit to their own primary care physician who may subsequently refer them to a surgeon to conduct a “cold biopsy” to remove the growth or mass. The biopsy procedure can be time consuming and the patient may  undergo further waiting as the results are interpreted, confirmed and reported—often wasting precious treatment time for the patient. What pathology has done is take the specialist from outside the laboratory and place him/her directly into a clinical setting to provide one's direct expertise and services to patients. It allows a patient to bypass extra invasive and diagnostic procedures by allowing an individual to move directly to the next step, according to Janice Lage, M.D., professor and chair of the Department of Pathology and Laboratory Medicine, who helped establish the clinic.  “Most pathologists are not typically active in the realm of patient care,” said Lage. “They’re more used to seeing an individual’s tissues, blood or specimen and don’t normally interact with their patients directly. It takes a certain type of pathologist who is comfortable with interacting with patients as well as one who enjoys their work to do this. They must be able to perform the procedure and be prepared to sit down with the patient before, during and afterwards to consult and relay information.”  Normally, MUSC pathologists are on call to perform an average of 1,400 FNAs per year. The technique is performed on patients with palpable or deep-seated lesions (lung and adrenal cancers) both at the bedside or at clinics throughout the medical center, Hollings Cancer Center and McClennan Banks. Expanding FNA services to the East Cooper site progressed after the Pathology Department opened an office and blood drawing site to support lab services with other MUSC clinics in 2002.  “In a way, a pathologist can help in the decision tree of a patient,” Lage said. “Instead of starting at the beginning with a mass, the FNA patient can end up halfway down the tree knowing more—type of mass and cells present—so that the patient can be referred to the appropriate treating physician.” Lage believes their biggest challenge continues to be educating Lowcountry physicians and public about the many advantages of using FNA. She hopes in several years, the service can be expanded and made more available for tri-county patients at clinics or other practice sites. Other advantages of the FNA biopsy is its use in other ancillary tests related to breast cancer and other diseases. For patients diagnosed with thyroid cancer, FNA results can help guide surgeons in the type of operative procedure that’s necessary for a positive outcome.    Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.