FINE NEEDLE ASPIRATION CYTOLOGY(FNAC)-AN

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Transcript of FINE NEEDLE ASPIRATION CYTOLOGY(FNAC)-AN

  • FINE NEEDLE ASPIRATION CYTOLOGY(FNAC)-AN OVERVIEWProf. Tamal Kanti Ghosh MDMedical superintendent Cum- Vice Principal.School of Tropical Medicine, Kolkata

  • Sample of cells aspirated from suspicious mass for diagnostic purpose-material converted to cytological sample for microscopic examination FNAC

  • HISTORY

    FNAC dates back to 19th Century St. Barthalomews Hospital-Surgeon Stanley & Earle - Aspiration from LiverSt.Paget advocated aspirationin lumpsMenetier- 1st Lung ASPIRATIONGreigg& Gray - 20th Century beginning L. Nodes in trypanosomiasis

  • Gutherei -1921-first to use 21 g needleMartin , Ellis & Stewart First large scale study of 2500cases using 18 g needle

  • Zajicek of Karolinska Hospital Stockholm FNAC to international attention in 1980s till than not used because :Lack of confidence in sensitivity & specificityFear of tumor implantation along the tractApprehension of lawsuitsReluctance

  • FNAC

    Application:Diagnosis of palpable lesionBreast, thyroid, superficial soft tissue mass, salivary gland, palpable abdominal lesions testicles, other accessible sites prostrate, pelvic organs, bones , joints & lung

  • FNAC : Advantages

    FNAC OPD procedureMinimal invasivecost effectiveNo anaesthesiaRapid safe & painlessMultiple /repeated attempt possibleNo fibrosisDefinitive diagnosis in inoperable casesRapid DiagnosisAspirator-Reporter

  • Procedure :Materials :Syringe- 10/ 20 ml Needle - 25-20 g 38mm(l)0.6-0.9mmin ext diameter, Std 21 g 38 mmLarger needles 80-120, 200mm (Transrectal/vag)Syringer holder Franzen handleGlass SlidesFixatives: 95% ethanol/ ether alcohol 50:50

  • Method of aspirationPositionExaminationCleaningFixing-massNeedle insertionWithdrawl of plungerTo & fro movementTermination of aspirationRelease of suctionApplication of pressure with fingers

  • Preparation of FNA smearsWet fixedDry Fixed

  • STAININGH&EPAPMGGSPECIAL STAINING;Alcian blue Mucicarmine,PAS} carbohydrateMethyl violet,Congo red } AmyloidBacteria, Fungus

  • ASPIRATION FROM SPECIAL LESION/BODY SITESCYSTTHYROIDLUNGPROSTRATETESTISABDOMINAL FAT- PARA UMBILICAL FOR AMYLOIDOSISGUIDED FNAC -USG, CT

  • Microbiological studyCell BlockImmunocytochemical studyImage analysis & morphometryFlow cytometryUltrastructural studiesMol Biology Tech

  • COMPLICATIONS & HAZARDS OF FNACHAEMATOMAINFECTIONPNEUMOTHORAXDESSEMINATION OF TUMORVASOVAGAL ATTACK

  • PRECUTIONS & CONTRAINDICATIONSBLEEDING DISORDERLIVER FNA- P Time (PTI >80%)/OBST JAUNDICELUNG- EMPHYSEMATOUS/ PULMO HYPERTENSIONPANCREATITISADRENAL TUMOR-PHEOCHROMOCYTOMA

  • LIMITATIONSSMALL NO OF CELL POPULATION IN SAMPLEADEQUACYLACK OF CLINICAL DATAARTIFACTS