fine needle aspiration cytology by rahul raj

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FNAC

FNAC

CLINICAL SKILLS REQUIRED

Familiarity with general anatomy eg thyroid vs other neck swellingAbility to take a focused clinical historySharp skill in performing physical examination eg solid vs cystic, benign vs maligant lesions

Clinical skill required -2Good knowledge in normal cellular elements from various organs and tissue and how they appear on smears eg fats cells vs breast tumor cellsComprehensive knowledge of surgical pathology

MATERIALS REQUIREDNeedle 21 G /27 GDisposable syringe 10 20 mlNew glass slidesSyringe handleToluidine blueCoplin jarSpirit swabCotton gauge / dry swabAdhesive tapPencilTooth picksWaste disposable containers (blood stained products , non stained products)FNAC reporting formBedTableTray for carrying the slides PROCEDURE

PrincipleThe negative pressure created within the syringe by aspiration holds the tissue against the sharp cutting edge of the needle. So that the tissue will be cut by the cutting end of the needle and accumulates with in the lumen of the needle / syringe tip Procedure contPut the clean glass slides on the tableFill the coplin jars with ethanolExplain the procedure to the patient and get the written consentPlace the patient on the aspiration table in supine position or any position which will expose the desired aspiration siteExpose the aspiration siteClean the site with spirit swab from center outwards in concentric fashionLeave the area to dryProcedure conOpen the syringe from the plastic wrapper and the needle to the syringe tipCheck the syringe by aspirating , air in and out of the syringe , put the needle in the syringe holderPrick the lump by vertical technique, in which the needle is perpendicular to the skinAspirate the lump by pulling the piston, Rotate the needle and continue to aspirate. Move the back and forth and aspirate

Procedure con.If the lump is big change the direction of the needle and again aspirateif the lesion is huge, multiple sites aspiration may be neededStop the aspiration, Let the piston go to its resting position, withdraw the needlePut a dry swab/cotton gauze over the aspiration site and put an adhesive tap. Ask the patient to press the site for 5-10 min.Put a drop of aspirate on the surface of a clean glass slide 2cm away from the end of the slide

Procedure con.Immediately, spread the material on the slide by holding the slide with one hand and putting the flat surface of an another glass slide over the material and move it smoothly, gently and swiftly to the other end of the slide by applying gentle pressureSlides planned for papanicolaou stain are subjected into ethanol so that the aspirated material is totally submerged in the alcohol solutionSlides planned to giemsa stain are left to dry in open airSlides planned for immunocyto or histo should be prepare in pretreated(albumenized) slides or pre-coated adhesive slides prepared for the designated techniques.

DOCUMENTATIONDate on which the tests doneFixative used for wet smearName of the pathologist/physician/radiologist performing the test.Name of the laboratory personnel assistingClinical diagnosisTransfer the slide to the staining table in cytopathology laboratoryDate of preparation of fixativeGrease free and clean slides should be used

2.A good quality 10ml or 20ml syringe should be used to create sufficient negative pressure to aspirate tissue

3.An experienced technologist or laboratory personnel should perform the staining procedure

Dried smear are stained by Romanowsky staining method, especially May Grunwald-GiemsaOther stains can be applied according to the need of diagnosis e.g.Gram`s ,Z.N stain, PAS, Alcian blue stainWet fixed smear by papanicolaou stain1.5% glutaraldehyde fixative solution for EM studyComplication of FNACFNA is considered one of the safest invasive diagnostic procedures though complication were estimated at 0.03% of casesComplications of the FNAC of superficial masses include needle track seeding; pnuemothorax with breast, axilary, and supraclavicular masses, transient acute swelling(thyroid) hematomas, and histological alterations.More serious and sometimes life threatening complications may occur with aspiration of deep organs. In the chest , these includes pnuemothorax, massive hemorrhage.

SURGICAL BIOPSYFNACDIAGNOSISDIAGNOSTIC DIFFICULTYANESTHETICLENGTH OF PROCEDUREREPORT AVAILABLE

Histo pathologicalNarrow

YesMore than 5 min

2-4 daysCyto pathologicalBroad

No(rare)Less than 5 min

2-4 hrsFALSE POSITIVECOSTSPECIMEN OBTAINEDTRAUMANoneRelatively highIn operating theatreyesRareEconomicalAs out patientLittle if anyThank u