Ppt

1. Fine- Needle
Aspiration
Cytology(FNAC)
Dilum Weliwita
B.Sc. Nursing (U.K)

2. FNAC - definition
 Aspiration of cells/ tissue fragments using
fine needles (21, 22 , 23, 25 Gauge) ;
external diameter 0.6 to 1.0 mm
 1.5 inches long needle ( radiologists use
longer needles)
 Diagnostic materials in the needle and
not in the syringe even in cystic lesions

3. Clinical skill 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

4. 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
tumour cells
 Comprehensive knowledge of
surgical pathology

5. Clinical skill required -3
 Ability to translate traditional tissue
patterns of lesions to their
appearance in smears

6. Cytology vs Histology
Papillary carcinoma of thyroid - follicular variant

7. Cytology vs Histology - 2
Granular Cell Myoblastoma

8. Who should do FNA?
 Clinicians
 Cytotechnologists
 Radiologists
 Pathologists
The one who examines the patients , does the aspiration,
makes the smears, interprets the cytology
is the best one to do FNA -
PATHOLOGIST

9. Cont:
 Ideal is specialist physician to
conduct the procedure
 Eg: transthorasic biopsy –by
radiologist with guidance of USS or
CT guided,
 Brain biopsy by neurosurgeon
 Transbronchial biopsy by
pulmonologist in the bronchoscopy
suite

10. Current status
 Palpable lesions
 Outpatients , in- patients
 Thyroid , breast, lymph nodes,
salivary glands , soft tissue lumps...
 Lung, intra-abdominal and
retroperitoneal by radiologic imaging
: CT, ultrasound, flouroscopy
,endoscopy

11. LIMITATIONS
 Soft vs hard ( bone) lesions
 Solid vs cystic lesions
 Poor cellular yield vs poor technique
 Reactive vs specific diseases eg
reactive lymphadenitis vs Hodgkins
disease
 Diffuse vs nodular lymphoma

12. Complications
 Needle trauma
– granulation tissue
formation
– granuloma
formation
– Needle linear tract
haemorrhage
– tissue necrosis
 Needle track
seeding - testicular
tm,
 Hematoma
 Pain
 Pneumothorax???

13. Complications: (Minor)
 Vasovagal reaction
 Small hematona
 Pain persisting for a few hours –ice
pack, analgesia can be given

14. Complications (Major)
 Rare
 Infection
 Bleeding
 No studies show, any adverse effects
of FNAC yet

15. ADVANTAGES
 Fast - early diagnosis
 Less pain, less trauma, minimal
discomfort to patient
 No anaesthesia
 Acceptable by patients and doctors
 Accurate, early diagnosis
 Low risk of morbidity and mortality
 Low cost

16. Cont:
 False- negative rate of FNAC is 3%-
5% due to sampling problems rather
than interpretative error
 It can lead to specific diagnosis in
more than 90%

17. How to interpret?
 Aspiration materials eg colloid,
blood, mucus?
 Cellular yield vs acellular yield
 Smear pattern - 3 dimensional balls
vs flat monolayered sheet os cells
 Cohesiveness vs discreet cells
 Cell morphometry

18. The nurse’s role
 Involved in care through the entire
process, first contact until discharge
 Patient education
 Explain the procedure, answer the
questions
 Screening for coagulation such as
PT, aPTT and conduct , Review prior
to procedure
 History, current medication eg:
warfarin , asprin

19. Nurse’s role cont:
 Along with the physician informed
consent and sign forms.
 Complete nurse’s documents
 When starts, responsible for
monitoring the patient. Either
administers the drug accordingly
 Vital signs

20. Nurse’s role cont:
 Provide emotional support as needed
 Direct the specimen and request
necessary test which advised by the
doctor.
 Once completed, dresses puncture
site with adhesive dressing
 Continues to assess the site for
bleeding or swelling
 if major organ or sedation involves
pt need to recover least 30 min

21. Nurse’s role cont:
 Checking the patient’s vital sign till
discharge
 Provide the discharge instructions
and answer any questions

22. Future directions
 Aspirating non palpable lesions
using MRI
 Molecular pathology eg In Situ
Hybridization
 Replacing diagnostic surgical
pathology?
 Combined with MRI - replacing
autopsy?

23. Future Direction
 Genomics and proteomics in DNA
and protein typing
 Polymerase chain reaction
 Thus practice of FNAC continues to
evolve, with investigation and
innovation focused on several areas

24. SUMMERY
 FNAC is simple, accurate, fast
economical procedure that
frequently offers a viable alternative
diagnostic modality to surgery
 Presence of nurse during procedure
ensure patient’s comfort and safety
and positive experience for the
patient and other health care
professionals involved

25. Questions????????????????????

26. THANK YOU