Fine needle aspiration cytology is a technique whereby cells are obtained from a lesion using a thin bore needle and smaers are made for cytopathological diagnosis.

1. FNAC Techniques
DR SANDEEP SINGH
GMC. KNW

2. What is FNAC
Fine needle aspiration cytology is a technique whereby cells are
obtained from a lesion using a thin bore needle and smaers are made
for cytopathological diagnosis.
Technique is based on the fact that tumor cells are less cohesive and are
easily aspirated.
Rapid, reliable , less invasive and safe diagnostic procedure for
superficial palpable masses.
Under USG/CT guidance nonpalpable, deep masses can be aspirated.

3. Advantages
It has many advantages over histopathology.
◦ Simple technique
◦ OPD based
◦ Quick and economical
◦ No need of anesthesia
◦ Multiple attempts or repeat procedure can be done without much inconvenience.
◦ Can eliminate tissue biopsy in many conditions
◦ Special techniques like IHC, Molecular techniques are also possible in FNAC material.
◦ High sensivity and specificity
◦ Less invasive

4. Limitations
Significant loss of tissue architecture
Difficult to differentiate in situ from invasive carcinoma
Not possible to comment on capsular and lymphovascular invasion
Considerable training is needed for interpretation.

5. Complications
Minor hematoma formation
Bleeding from site of aspiration
Surgical emphysema in case of intrathorasic FNAC
Rarely Anaphylactic reaction in case of rupture of hydatid cyst.

6. Comparison of FNAC and HP
FNAC Histopatholgy
Rapidity Very fast Takes time for processing
of tissue ,atleast one day
Procedure OPD Require OT
Cost Cheaper Costly
Ancillary studies Possible like IHC, FC,
Culture, Molecular studies
Possible
Sensivity and specificity Good Excellent, Gold standard

7. Contraindications
Avoid in cases of bleeding diathesis.
Avoid in case of hydatid cyst
Avoid in case of aneurysmal cyst.

8. Applications
PALPABLE MASS LESIONS IN :
◦ Lymph nodes
◦ Breast
◦ Thyroid
◦ Salivary glands
◦ Soft tissue masses
◦ Bones
NON PALPABLE MASS LESIONS IN
:
Abdominal cavity
◦ Liver mass
◦ Pancreatic mass
◦ Retroperitoneal masses
Thorasic cavity masses
◦ Lung mass
◦ Mediastinum mass
Scrotal FNAC

9. Basic Techniques

11. FNAC Room
Well ventilated room
Well Lighted
Preferably near to hospital OPD
Equipped with examination bed, working table, and chair
Privacy should be maintained

15. Steps of FNAC
Read carefully FNAC requisition form filled by clinician ( site, patient
details, Other relavant information)
Identify the patient
Take proper consent
Take proper clinical history (Chief complaints, duration, relevant tests
and imaging reports)
Examine site of lesion

16. Technique

17. FNA with Aspiration
1. Clean the lesion by spirit swab
2. Fix the swelling by one hand to immobilize it.
3. Insert the needle with syringe and piston handle
attached with it.
4. Pass the needle back and forth by moving the pistol
handle.
5. Create negative pressure
6. Release the handle
7. Take out the handle

18. 8. Remove the needle from syringe and take air in the syringe.
9. Reattach the needle with a syringe.
10. Push the aspirate out of the syringe to a fresh glass slide
11. Spread the material on the slide with the help of a spare glass slide.
12. Keep few slides in 95% ethanol for wet fixation.
13. Tell the patient to press the puncture site firmly with a piece of dry cotton
for a few minutes.

22. FNAC without Aspiration
Hold the swelling tightly
Insert the needle in swelling
Move the needle gently back and forth
Withdraw the needle and attach it with a syringe full of air
Push the material on glass slide

28. Dry aspirate smearing- one
step

29. Wet sample smearing – two step
Dry sample smearing
Wet sample smearing – two
step in single slide
Wet sample smearing – two
step in two slides

30. Macro appearance of stained smears
A. smear of ‘dry’ sample ; cell clusters seen as blue dots, evenly spread;
B. Smear of ‘wet’ sample by two-step smearing; mainly blood at top end, cell clusters
concentrated and evenly spread in the thin mid portion;
C, D poorly prepared smears of bloody material, partly dried or clotted before smearing.