FNAC involves aspirating cells using fine needles from lesions to determine if they are benign or malignant. It requires clinical skills like anatomy knowledge and physical exam proficiency. Cytology examines cell patterns in smears while histology looks at tissue. Pathologists are best for conducting FNAC as they examine patients and interpret results. Nurses play an important role by educating patients, obtaining consent, monitoring patients during the procedure, and ensuring follow-up care. FNAC is fast, accurate, and low-risk, frequently providing a diagnosis to guide treatment.

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