Coding Fine Needle Aspiration
Do we have to code the FNA as histology? And why? It may contain cells but not tissue.
If FNA is histology, then we have all been coding this wrong for multiple years. If it says “suspicious for,” we should then count the ambiguous terminology for FNA as the date of diagnosis. If so, we will need to let stage registries and COC facilities all know this.
Code Fine Needle Aspiration (FNA) as 1-Histology in Dx Confirmation when reporting to FCDS
When I entered this industry, I had a hard time with it. After all, in pathology and in many publications and definitions, FNA is treated as Cytology. Then I read to code it to 1(Histology) in the Diagnostic Confirmation in the Data Acquisition Manual.
While some experts, including Pathologists, may cite Fine Needle Aspiration (FNA) as cytology, other medical professionals may refer to it as the least invasive of the biopsies.
But why can FNA be a biopsy? Because in addition to cells and fluid, FNA may also contain small tissue fragments. The size of the needle matters, and with a good size needle small pieces of tissue can also be collected. That solves the mystery!
For Florida Cancer Registry purposes, FNA must be coded to 1 Histology in the Diagnosis Confirmation section.
When do you code Cytology?
When you encounter any of the following secretions:
“Cytology is the examination of cells rather than tissue. This would include sputum smears, bronchial brushings, bronchial washings, prostatic secretions, breast secretions, gastric fluids, spinal fluid, peritoneal fluid, urinary sediment, and cervical and vaginal smears. This does not include FNA”. DAM 2025
Even though the Solid Tumor Rules (STR) may treat Breast FNA as cytology (see below), if you report abstracts to FCDS, you must code it to Histology as we consider it comparable to a biopsy.
If you encounter ambiguous terminology while reading an FNA report, you should record the date of the FNA as the date of diagnosis, as instructed in the Date of Diagnosis Coding Instructions.
DAM 2025:
FNA is a Histological confirmation, and it applies for establishing a date of diagnosis.
Can high levels of calcitonin be a sign of thyroid cancer?
Yes, high calcitonin levels (hypercalcitoninemia) can be a sign of thyroid medullary carcinoma, as calcitonin hormone levels can be used as a cancer marker for thyroid cancer. C-cells are the origin of thyroid medullary carcinoma with an excess of calcitonin production. Remember that calcitonin is produced by C-cells, which are found between the thyroid follicles.
Normally, calcitonin is produced when there is an excess of calcium (hypercalcemia) in the blood. Calcitonin is the hormone that lowers excess calcium in the blood and brings it back to normal healthy circulating levels. That maintains homeostasis in the body.
However, high levels of calcitonin (hypercalcitoninemia) are not exclusive to thyroid cancer. Thyroid hyperplasia may produce high levels of calcitonin. Also, Calcitonin may be elevated in other non-cancer conditions. Other cancers that have nothing to do with the thyroid gland may produce ectopic calcitonin. Some examples are Stomach, Lung, Pancreas and Breast cancers.
What is the reason that other cancers not related to the thyroid gland may produce calcitonin excess?
Some cancers may trigger a humoral paraneoplastic syndrome. Other cancers not related to the thyroid gland may undergo genetic changes that give the cancer cells the ability to produce calcitonin. Furthermore, other crazy cancer cells may revert to a more primitive cell state where they can produce an excess of hormones, such as calcitonin.
Metastasis to bone of many cancers unrelated to the thyroid gland may cause bone reabsorption. As bones disintegrate, calcium levels increase. This hypercalcemia in the blood stimulates the thyroid gland to release calcitonin to lower extremely high calcium levels.
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