how to present a fnac

3. GENERAL
COSIDERATION
The purpose of FNA to obtain diagnostic material for cytological study from
organs that do not shed cells spontaneously. The bonemarrow, spleen, liver,
breast, thyroid gland and lymph nodes are typical targets of the diagnostic
procedure.
Sampling of tumors by means of narrow gauge needle was first described in
1930 in USA and become popular in late 1950s.
Sophisticated radiological imaging, computed tomography(CT),
ultrasonography(USG),and image intensified fluoroscopy have been added
to this method to perform FNA more accurately and precisely.

4. CLINICAL SKILLS REQUIRED
Familiarity with general anatomy eg thyroid vs other
neck swelling
Ability to take a focused clinical history
Sharp skill in performing physical examination eg
solid vs cystic, benign vs maligant lesions

5. Clinical skill required -2
Good knowledge in normal cellular elements from
various organs and tissue and how they appear on
smears eg fats cells vs breast tumor cells
Comprehensive knowledge of surgical pathology

6. Medical technologist may be quite helpful with the
aspiration service , ensuring that the smears are
prepared and fixed and materials for cell block,
immunocyto- or histochemistry , os well as other
specialized techniques handled appropriately.

7. MATERIALS REQUIRED
1. Needle 21 G /27 G
2. Disposable syringe 10 – 20 ml
3. New glass slides
4. Syringe handle
5. Toluidine blue
6. Coplin jar
7. Spirit swab
8. Cotton gauge / dry swab
9. Adhesive tap
10. Pencil
11. Tooth picks
12. Waste disposable containers (blood stained products , non stained products)
13. FNAC reporting form
14. Bed
15. Table
16. Tray for carrying the slides

8. PROCEDURE
Principle
The negative pressure created within the syringe by
aspiration holds the tissue against the sharp cutting
edge of the needle. So that the tissue will be cut by the
cutting end of the needle and accumulates with in the
lumen of the needle / syringe tip

9. Procedure cont…
1. Put the clean glass slides on the table
2. Fill the coplin jars with ethanol
3. Explain the procedure to the patient and get the
written consent
4. Place the patient on the aspiration table in supine
position or any position which will expose the desired
aspiration site
5. Expose the aspiration site
6. Clean the site with spirit swab from center outwards
in concentric fashion
7. Leave the area to dry

10. Procedure con……
8. Open the syringe from the plastic wrapper and the
needle to the syringe tip
9. Check the syringe by aspirating , air in and out of the
syringe , put the needle in the syringe holder
10. Prick the lump by vertical technique, in which the
needle is perpendicular to the skin
11. Aspirate the lump by pulling the piston, Rotate the
needle and continue to aspirate. Move the back and
forth and aspirate

11. Procedure con…….
12. If the lump is big change the direction of the needle and
again aspirate
13. if the lesion is huge, multiple sites aspiration may be
needed
14. Stop the aspiration, Let the piston go to its resting
position, withdraw the needle
15. Put a dry swab/cotton gauze over the aspiration site and
put an adhesive tap. Ask the patient to press the site for
5-10 min.
16. Put a drop of aspirate on the surface of a clean glass slide
2cm away from the end of the slide

12. Procedure con….
17. Immediately, spread the material on the slide by holding
the slide with one hand and putting the flat surface of an
another glass slide over the material and move it
smoothly, gently and swiftly to the other end of the slide
by applying gentle pressure
18. Slides planned for papanicolaou stain are subjected into
ethanol so that the aspirated material is totally
submerged in the alcohol solution
19. Slides planned to giemsa stain are left to dry in open air
20. Slides planned for immunocyto or histo should be
prepare in pretreated(albumenized) slides or pre-coated
adhesive slides prepared for the designated techniques.

14. DOCUMENTATION
1. Date on which the tests done
2. Fixative used for wet smear
3. Name of the pathologist/physician/radiologist
performing the test.
4. Name of the laboratory personnel assisting
5. Clinical diagnosis
6. Transfer the slide to the staining table in cytopathology
laboratory
7. Date of preparation of fixative

15. 1. Grease free and clean slides should be used
2.A good quality 10ml or 20ml syringe should be used to
create sufficient negative pressure to aspirate tissue
3.An experienced technologist or laboratory personnel
should perform the staining procedure

16. Fixatives and
stains
1. Dried smear are stained by Romanowsky staining
method, especially May Grunwald-Giemsa
2. Other stains can be applied according to the need of
diagnosis e.g.Gram`s ,Z.N stain, PAS, Alcian blue stain
3. Wet fixed smear by papanicolaou stain
4. 1.5% glutaraldehyde fixative solution for EM study

17. Complication of FNAC
FNA is considered one of the safest invasive diagnostic
procedures though complication were estimated at
0.03% of cases
Complications of the FNAC of superficial masses
include needle track seeding; pnuemothorax with
breast, axilary, and supraclavicular masses, transient
acute swelling(thyroid) hematomas, and histological
alterations.

18. More serious and sometimes life threatening
complications may occur with aspiration of deep
organs. In the chest , these includes pnuemothorax,
massive hemorrhage.

19. COMPARISON
SURGICAL
BIOPSY
FNAC
•DIAGNOSIS
•DIAGNOSTIC
DIFFICULTY
•ANESTHETIC
•LENGTH OF
PROCEDURE
•REPORT AVAILABLE
Histo pathological
Narrow
Yes
More than 5 min
2-4 days
Cyto pathological
Broad
No(rare)
Less than 5 min
2-4 hrs
•FALSE POSITIVE
•COST
•SPECIMEN OBTAINED
•TRAUMA
None
Relatively high
In operating theatre
yes
Rare
Economical
As out patient
Little if any

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