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

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 2

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 3

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 4

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

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

7. Cytology vs Histology - 2
Granular Cell Myoblastoma 7

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 8

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 9

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 10

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 11

12. 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

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

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

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 15

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% 16

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 17

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 18

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 19

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 20

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

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

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 23

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 24

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

26. THANK YOU 26