Topics in Clinical - Outpatient Cytopathology Center

T o p i c s i nC l i n i c a lF N AAspiration Biopsy Cytology October 2007NATIONAL BREAST AND CERVICAL CANCEREARLY DETECTION PROGRAMIn 1990, Congress passed the Breast and CervicalCancer Mortality Prevention Act, creating the CDC’sNational Breast and Cervical Cancer Early DetectionProgram (NBCCEDP). This program is designed tohelp low income, uninsured, and underserved womengain access to screening programs for early detectionof breast and cervical cancers. However, as reported ina front page article of the Wall Street Journal onSeptember 13, 2007, patients can get caught in aloophole and not get their medical care covered unlessthey are referred to designated providers, clinics orhospitals. Outpatient Cytopathology Center is one ofthe contracted NBCCEDP providers.Diagnostic and screening services covered byNBCCEDP include clinical breast examinations,mammograms, and Pap tests.Additionally, for women whosescreening outcome is abnormal,further diagnostic testing is covered.The diagnostic testing servicesinclude fine needle aspiration biopsyand surgical consultation.Implementation of NBCCEDPThe NBCCEDP has beenimplemented in all 50 states, four USterritories, the District of Columbiaa n d t h i r t e e n A m e r i c a nIndian/Alaskan organizations.Tennessee began its outreachprogram in 1997.Since 1991, NBCCEDP has helpedover 2.5 million women, facilitatingmore than 5.8 million screeningexaminations and more than 2.8NationalBreast and CervicalCancer Early DetectionProgramNortheast Tennessee423-979-3200Kathy SnyderVirginia879-482-3468North Carolina919-733-4534Nationally1-888-232-4636www.cdc.gov/cancer/nbccedpmillion mammograms. It has resulted in the diagnosisof more than 22,000 breast cancers and 1,500 cervicalcancers.Who qualifies for NBCCEDP?To receive services from this program, each state mayhave slightly different requirements, but the followinggeneral guidelines must be fulfilled.• A woman, age 50 years or older. For patients ages40-49 who have a personal family history of amother, daughter or sister with breast carcinoma orhave an abnormal clinical breast examination, theage criteria may be waived.• Have no health insurance. This means that thepatient is not enrolled in Medicaid orMedicare (or the patient has MedicarePart A only), their insurance does notcover Pap tests or mammograms, orthe patient cannot pay their insurancedeductible.• The patient has a low yearlyincome. The yearly income mustmeet the guidelines set by theprogram based on the number ofpeople in the home (200% of theFederal Poverty Guidelines). Programstaff can assist in determiningwhether or not a patient meets thisrequirement.If a patient between 18-39 years hasan abnormal clinical examination,coverage may be obtainable. Theprovider must call the appropriate©2007 Outpatient Cytopathology Center

health department and discuss the patient’s findings tosee if she may be enrolled in the program.Who can provide care for NBCCEDP patients?Services are provided by local health departments,community-based health clinics and private providers.Providers must enroll in NBCCEDP in order to seepatients in the program. You may elect to be either aprimary screening provider, a referral provider, orboth. Providers must agree to follow programguidelines and are reimbursed only for services that arelisted on the fee schedule. The fee schedule followsMedicare reimbursement. To enroll, call your Breastand Cervical Cancer Early Detection Program regionalcoordinator at your Regional Health Office.OCC and the NBCCEDPThe Outpatient Cytopathology Center (OCC) is aNBCCEDP provider for patients who have anabnormal clinical breast examination. At our facility,we have extensive experience in performing fineneedle aspiration biopsies. Fine needle aspirationbiopsies can be performed on a clinically suspiciouspalpable breast mass, or of a mass that we can visualizewith ultrasound. Both the aspiration biopsy procedureand the pathologic interpretation are performed atOCC. This aids in the accuracy of the diagnostic test aswell as quicker turn around time for the results.To schedule a patient for an appointment, please callour office and identify the patient as a participant ofthe NBCCEDP. The patient will be scheduled for anappointment in a timely manner. If a patient is notalready enrolled in the NBCCEDP, our staff can helpfacilitate their enrollment.About FNAFine needle aspiration biopsy is a well-tolerated minimallyinvasive diagnostic procedure. At OCC, we use a 25-gaugeneedle. This allows for adequate sampling and minimizesbleeding, bruising, and patient discomfort.FNA is gaining popularity in the United States as a biopsyprocedure for sampling breast lesions. Cells procured byFNA can be examined by light microscopy or be used forflow cytometry studies, immunohistochemical stains ormolecular studies. In experienced hands, FNA can providereliable diagnostic information that can be used to triagepatients for the next appropriate medical step, be it surgicalexcision, pharmacologic therapy or clinical follow up.Findings from the National Comprehensive Cancer Network(NCCN) study published in the February 1, 2006 edition ofOb. Gyn. News “demonstrated that breast cancers initiallyaddressed by needle biopsy - either fine needle aspirationbiopsy or core biopsy - ultimately entailed fewer operationsof the breast, fewer total trips to surgery, and less time tocompletion of the diagnostic and surgical phases of cancercare.”AppointmentsTo schedule a patient, call the Outpatient CytopathologyCenter at 423-283-4734. If you have a patient with a breastmass who may qualify for the NBCCEDP, our personnelwould be happy to assist you.Company ProfileOUTPATIENT CYTOPATHOLOGY CENTER (OCC) is an independent pathology practice that specializes in performing and interpreting fine needle aspiration biopsyspecimens. OCC is accredited by the College of American Pathologists. The practice was established in 1991 in Johnson City, Tennessee. Patients may be referredfor aspiration biopsy of most palpable masses as well as for aspiration of non-palpable breast and thyroid masses that can be visualized by ultrasound. OCC is aparticipating provider with most insurance plans. Our referral area includes patients from Tennessee, Virginia, West Virginia, North Carolina, South Carolina,Kentucky and Georgia.Dr. RollinsS USAN D. ROLLINS, M.D., F.I.A.C. is BoardCertified by the American Board of Pathology inCytopathology, and in Anatomic and ClinicalPathology. Additionally, in 1994 she was inducted asa Fellow in the International Academy of Cytology.She began her training under G. Barry Schumann,M.D. at the University of Utah School of Medicine,subsequently completed a fellowship inCytopathology under Carlos Bedrossian, M.D. at St.Louis University School of Medicine, and hascompleted a fellowship in Clinical Cytopathologyunder Torsten Lowhagen, M.D. at the KarolinskaHospital in Stockholm, Sweden. The author ofnumerous articles in the field of cytopathology, Dr.Rollins also has served as a faculty member forcytopathology courses taught on a national level.OfficeOUTPATIENT CYTOPATHOLOGY CENTER2400 Susannah Street Suite AJohnson City, TN 37601(423) 283-4734(423) 610-0963(423) 283-4736 faxfna4321@mac.comMailing Address:PO Box 2484Johnson City, TN 37605-2484Monday – Friday8:00 am to 5:00 pmDr. StastnyJANET F. STASTNY, D.O. is Board Certified by theAmerican Board of Pathology in Anatomic Pathologyand has specialty boards in Cytopathology. Shecompleted a pathology residency at the University ofCincinnati and subsequently a one-year fellowship incytopathology and surgical pathology at the VirginiaCommonwealth University / Medical College ofVirginia. She was on the faculty at the University for7 years specializing in gynecologic pathology andcytopathology. She has written numerous articles inthe field of cytopathology and gynecologic pathologyand has taught cytopathology courses at nationalmeetings. She is currently involved on nationalcommittees dealing with current issues concerningthe practice of cytology.©2007 Outpatient Cytopathology Center