SlideShare a Scribd company logo
Fine- Needle
Aspiration
Cytology(FNAC)
Dilum Weliwita
B.Sc. Nursing (U.K)
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
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
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
Clinical skill required -3
 Ability to translate traditional tissue
patterns of lesions to their
appearance in smears
Cytology vs Histology
Papillary carcinoma of thyroid - follicular variant
Cytology vs Histology - 2
Granular Cell Myoblastoma
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
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
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
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
Complications
 Needle trauma
– granulation tissue
formation
– granuloma
formation
– Needle linear tract
haemorrhage
– tissue necrosis
 Needle track
seeding - testicular
tm,
 Hematoma
 Pain
 Pneumothorax???
Complications: (Minor)
 Vasovagal reaction
 Small hematona
 Pain persisting for a few hours –ice
pack, analgesia can be given
Complications (Major)
 Rare
 Infection
 Bleeding
 No studies show, any adverse effects
of FNAC yet
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
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%
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
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
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
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
Nurse’s role cont:
 Checking the patient’s vital sign till
discharge
 Provide the discharge instructions
and answer any questions
Future directions
 Aspirating non palpable lesions
using MRI
 Molecular pathology eg In Situ
Hybridization
 Replacing diagnostic surgical
pathology?
 Combined with MRI - replacing
autopsy?
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
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
Questions????????????????????
THANK YOU

More Related Content

Similar to 14054779.ppt

Renal Cancers Rationale
Renal Cancers RationaleRenal Cancers Rationale
Renal Cancers Rationale
fondas vakalis
 
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICS
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICSROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICS
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICS
Kanhu Charan
 
Oncoanesthesia.pptx
Oncoanesthesia.pptxOncoanesthesia.pptx
Oncoanesthesia.pptx
Dr. Ravikiran H M Gowda
 
Emergency ct-is it being overused dr.amarnath
Emergency ct-is it being overused dr.amarnathEmergency ct-is it being overused dr.amarnath
Emergency ct-is it being overused dr.amarnath
Teleradiology Solutions
 
Advance in lung cancer.pptx
Advance in lung cancer.pptxAdvance in lung cancer.pptx
Advance in lung cancer.pptx
Punnarerk Thongcharoen
 
medical thoracoscopy2022
medical thoracoscopy2022medical thoracoscopy2022
medical thoracoscopy2022
rambhoopal1
 
Anjali agrawal case discussion by experts
Anjali agrawal case discussion by expertsAnjali agrawal case discussion by experts
Anjali agrawal case discussion by experts
Teleradiology Solutions
 
Importance of a follow up ultrasound protocol in monitoring
Importance of a follow up ultrasound protocol in monitoringImportance of a follow up ultrasound protocol in monitoring
Importance of a follow up ultrasound protocol in monitoring
PrasunDas31
 
Surgical oncology
Surgical oncologySurgical oncology
Surgical oncology
Dr Ankur Shah
 
Vte 2014
Vte 2014Vte 2014
Vte 2014
Ihsaan Peer
 
testicular tumor
testicular tumortesticular tumor
testicular tumor
abdullah ali alhutam
 
Imagen Torácica
Imagen TorácicaImagen Torácica
Imagen Torácica
Cesar Rosenberg González
 
Advanced Cancer diagnosis (2).pptx
Advanced Cancer diagnosis (2).pptxAdvanced Cancer diagnosis (2).pptx
Advanced Cancer diagnosis (2).pptx
swatisheth8
 
Thyroid
ThyroidThyroid
Thyroid
Avinashbarfa
 
Carcinoma urinary bladder
Carcinoma urinary bladderCarcinoma urinary bladder
Carcinoma urinary bladder
Musfirah Tahir
 
Scar ectopic pregnancy
Scar ectopic pregnancyScar ectopic pregnancy
Scar ectopic pregnancy
AlkaPandey24
 
MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...
MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...
MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...
u.surgery
 
Scans and Ovarian Cancer: Everything You Want to Know
Scans and Ovarian Cancer: Everything You Want to KnowScans and Ovarian Cancer: Everything You Want to Know
Scans and Ovarian Cancer: Everything You Want to Know
bkling
 
Case Study: Recurrent myoma with menorrhagia
Case Study: Recurrent myoma with menorrhagiaCase Study: Recurrent myoma with menorrhagia
Case Study: Recurrent myoma with menorrhagia
Lyndon Woytuck
 
Metastatic diseases of nervous system
Metastatic diseases of nervous systemMetastatic diseases of nervous system
Metastatic diseases of nervous system
NeurologyKota
 

Similar to 14054779.ppt (20)

Renal Cancers Rationale
Renal Cancers RationaleRenal Cancers Rationale
Renal Cancers Rationale
 
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICS
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICSROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICS
ROLE OF RADIATION IN BONE TUMORS FOR ORTHOPEDICS
 
Oncoanesthesia.pptx
Oncoanesthesia.pptxOncoanesthesia.pptx
Oncoanesthesia.pptx
 
Emergency ct-is it being overused dr.amarnath
Emergency ct-is it being overused dr.amarnathEmergency ct-is it being overused dr.amarnath
Emergency ct-is it being overused dr.amarnath
 
Advance in lung cancer.pptx
Advance in lung cancer.pptxAdvance in lung cancer.pptx
Advance in lung cancer.pptx
 
medical thoracoscopy2022
medical thoracoscopy2022medical thoracoscopy2022
medical thoracoscopy2022
 
Anjali agrawal case discussion by experts
Anjali agrawal case discussion by expertsAnjali agrawal case discussion by experts
Anjali agrawal case discussion by experts
 
Importance of a follow up ultrasound protocol in monitoring
Importance of a follow up ultrasound protocol in monitoringImportance of a follow up ultrasound protocol in monitoring
Importance of a follow up ultrasound protocol in monitoring
 
Surgical oncology
Surgical oncologySurgical oncology
Surgical oncology
 
Vte 2014
Vte 2014Vte 2014
Vte 2014
 
testicular tumor
testicular tumortesticular tumor
testicular tumor
 
Imagen Torácica
Imagen TorácicaImagen Torácica
Imagen Torácica
 
Advanced Cancer diagnosis (2).pptx
Advanced Cancer diagnosis (2).pptxAdvanced Cancer diagnosis (2).pptx
Advanced Cancer diagnosis (2).pptx
 
Thyroid
ThyroidThyroid
Thyroid
 
Carcinoma urinary bladder
Carcinoma urinary bladderCarcinoma urinary bladder
Carcinoma urinary bladder
 
Scar ectopic pregnancy
Scar ectopic pregnancyScar ectopic pregnancy
Scar ectopic pregnancy
 
MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...
MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...
MR Guided Focused Ultrasound (MRgFUS) Overview of Present and Future Clinical...
 
Scans and Ovarian Cancer: Everything You Want to Know
Scans and Ovarian Cancer: Everything You Want to KnowScans and Ovarian Cancer: Everything You Want to Know
Scans and Ovarian Cancer: Everything You Want to Know
 
Case Study: Recurrent myoma with menorrhagia
Case Study: Recurrent myoma with menorrhagiaCase Study: Recurrent myoma with menorrhagia
Case Study: Recurrent myoma with menorrhagia
 
Metastatic diseases of nervous system
Metastatic diseases of nervous systemMetastatic diseases of nervous system
Metastatic diseases of nervous system
 

Recently uploaded

Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Health Advances
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
HongBiThi1
 
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachIntegrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Ayurveda ForAll
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
KafrELShiekh University
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
Pratik328635
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
Dr. Jyothirmai Paindla
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
rishi2789
 
Ketone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistryKetone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistry
Dhayanithi C
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
rishi2789
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
rishi2789
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
Dr. Jyothirmai Paindla
 
Top Travel Vaccinations in Manchester
Top Travel Vaccinations in ManchesterTop Travel Vaccinations in Manchester
Top Travel Vaccinations in Manchester
NX Healthcare
 

Recently uploaded (20)

Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
 
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachIntegrating Ayurveda into Parkinson’s Management: A Holistic Approach
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
 
OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1OCT Training Course for clinical practice Part 1
OCT Training Course for clinical practice Part 1
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1
 
Ketone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistryKetone bodies and metabolism-biochemistry
Ketone bodies and metabolism-biochemistry
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdfCHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf
 
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of HyperthyroidismRole of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
 
Top Travel Vaccinations in Manchester
Top Travel Vaccinations in ManchesterTop Travel Vaccinations in Manchester
Top Travel Vaccinations in Manchester
 

14054779.ppt

  • 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