Fine needle finesse.

IZINDABA 568 Tens of millions of rands are being wasted annually through unskilled aspiration of mass lesions and incorrect smears being submitted for analysis, according to Professor runs the Fine-Needle Aspiration Clinic there, says half of all specimens submitted for analysis are simply 'unusable' for diagnosis. She firmly believes that most young doctors overestimate their FNA skills. 'When I give them a short tutorial on what you can and can't aspirate, complications they can anticipate and how to perform the procedure, they look at me as if to say, ja, ja, we know – but very few can do it properly – you just have to look at the specimens we get'. Using Board of Health Care Funder codes and an annual average of 3 000 FNAs done in Wright's Tygerberg Hospital laboratory, the SAMJ calculated that by increasing adequate FNAspecimens to 90%, about R5 million could be saved in health care costs. The national tally almost certainly exceeds tens of millions of rands. Wright claims that the inadequacy rate for registrars who spend three months training in the FNAclinic at Tygerberg is less than 10%. 'As far as I'm concerned a 90% strike rate indicates competence,' she added. In the Western Cape, where tuberculosis is more prevalent than in any other province, FNA's take on an added significance in clinics and peripheral hospitals. Extrapulmonary TB (of the lymph nodes) has begun to skyrocket with the onset of the HIV pandemic. According to Wright, where the Tygerberg FNA clinic saw virtually no cases two years ago, it now sees at least two daily. FNAof these nodes is the simplest, quickest and most cost-effective way to obtain a diagnosis. A definitive diagnosis can be made the same day as an outpatient procedure and a significant number of patients can start treatment immediately. FNAalso provides a means of obtaining material for TB culture, which is increasingly important as the numbers of patients with multidrug-resistant strains of the TB organism increase. Says Wright, 'At the moment we are trying to see how effective FNAof children with clinically suspected extrapulmonary TB can be at Tygerberg Children's Hospital'. She added that in HIV-positive children it is particularly important to make a diagnosis and start treatment the day they are seen as they could develop complications very rapidly. While poor FNAtechnique and oversized syringe needles (Wright says the international definition recommends using one no larger than …