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

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 2

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 3

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 4

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

Cytology vs Histology Papillary carcinoma of thyroid - follicular variant 6

Cytology vs Histology - 2 Granular Cell Myoblastoma 7

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 8

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 9

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 10

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 11

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

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

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

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 15

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% 16

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 17

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 18

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 19

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 20

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

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

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 23

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 24

Questions???????????????????? 25

THANK YOU 26