A splenic needle aspirate can provide useful clinical information in many situations. However, it may fail to provide useful information in a number of situations.


Factors impacting the information available from a needle aspirate:

(1) adequacy of the sample and the amount of material required to make a diagnosis

(2) distribution and size of the pathologic process

(3) context of the splenic process


Adequacy of material:

(1) The aspirate may consist only of blood or miss the spleen entirely.

(2) Some lesions can be diagnosed on a small amount of material:

(2a) infectious agent (culture, PCR, etc)

(2b) lymphoproliferative disorder (flow cytometry)

(2c) malignancy (characteristic Immunoperoxidase pattern)


Distribution of the pathologic process:

(1) A diffuse process can be sampled by a "blind" aspirate.

(2) The sampling of a localized process should be image-directed.

(3) A localized process that is small may be easily missed.


Context of the splenic process:

(1) Determining if a lesion is a metastasis from a known tumor is easier than trying to diagnose a previously undiagnosed tumor.

(2) A primary splenic tumor may be more difficult to diagnose on limited material.

(3) The lesion aspirated may be completely unexpected.


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