The Role of FNAB (Fine Needle Aspiration

7/28/2019 The Role of FNAB (Fine Needle Aspiration

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1853 : James paget cell aspiratesfrom breast cancer

1904 : Greig and gray

trypanosomesfrom lymph node

1921 : Guthriemalignant lymphomafrom lymph node

1930 : Martin and Ellis diagnose a varietyof swellingin memorial hospital in NewYork

FKUI : begin 1989


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Distinguish benign from malignant lesions

Classify neoplasms and others

pathologic processes


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The patient

Minimal pain and post aspiration discomfort

Anesthesia is rarely necessary Can be used in high risk patients

Usually an outpatients procedure

Save time and hospitalization

Rapid alleviation of anxiety

More time to adjust to other procedures


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Clinical management Easily repeated

Allows sampling of multiple area with minimal trauma

Minimal disturbance of tissue planes for the solepurpose of diagnosis

Confirm malignancy of a nodule, but leaves it intactto monitor therapy by clinical examination or byrepeated aspiration

Therapeutic for some masses ( cysts and abscesses) Does not require extensive training of physicians

Quick feedback help in training and planning otherinvestigative procedures


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The laboratory

Simple, inexpensive equipment

Excellent cell preservation due to rapidfixation

Allows studies requiring freshly harvested cells

material can be obtained for other

examination ( microbiology, moleculartechnique, cytogenetic studies, enzymaticassay, stem cell culture etc)


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Marked hemorrhagic diathesis increasesthe risk of a significant hemorrhagic

Highly vascular tumors

Aneurysm or a vascular malformation

Deep organ(specific for each organ) severe cough, bullous emphysema,

pulmonary hypertension, respiratory failurein the case of lung aspiration

Liversevere jaundice, suspicious ofhemangioma or hydatid disease


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1. Superficial organ/ nodule Lymph node

Thyroid

Breast

Salivary gland

Others nodule

2.Deep organ by imaging guidance liver

Intraabdominal mass

Unpalpable mass

etc


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FNAB

DEFINITIVE

DIAGNOSIS ?Depend on :

- Organ- disease (diagnosis)

- need ancillary technique ( Imunocytochemistry,

molecular technique, etc )

- consensus


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Dawson et al (1998) : excellent result inbreast cancer diagnosis(35 y.o or younger)

Cohen et al (1987) and Ljung et al (2001) :correct diagnosis in 97% - 98% of patients

Stahl (1996) : suggested that asking thepatient to indicate the location of the lesionis more reliable than actual palpation

Procedures may be used : Palpable lesion ( solid, cystic)

Non-palpable lesion ( mammography, USG, MRIetc)


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Smear or cell block suitable for

ancillary examination

ER,PR, Ki-67 (proliferation factor), HER-2 Limitation of FNAB

Result of FNA is atypical or suspicious :

the procedure should be repeated,

another opinion or

The lesion should be excised for histopatologicexamination


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Protokol penatalaksanaan pasien (National Cancer Institute ConsensusConference on the uniform approach to breast FNAB )


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PENYEBAB DIAGNOSIS FALSE-NEGATIVE Kegagalan mendapatkan sampel yang

representative, berhubungan langsung dengan

karakteristik tumor (size, lokasi, derajat fibrosis,tipe histologik, diferensiasi), faktor tehnik

Kegagalan pengenalan sel ganas,berhubungan dengan pengalaman ahlipatologi

PENYEBAB DIAGNOSIS FALSE-POSITIVE Interpretasi yang kurang tepat pada lesi atipik

Preparasi slide buruk


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INSUFISIENSI /UNSATISFACTORY( NOTREPRESENTATIVE)

NEGATIVE (BENIGN LESION) INCONCLUSIVE (SUSPICIOUS)

POSITIVE FOR MALIGNANCY


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Invasiveductal

carcinoma


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FNAB accepted by head-neck surgeon asan excellent

Zaijcek, 1974 ; Batsakis et al, 1992; Boccato et

al 1992 primary methods of evaluatingspace occupying lesion of the salivary glands

FNA of salivary glands : Is the mass of salivary gland origin ?

If the mass is of salivary gland origin, is it neoplastic ornon-neoplastic ?

If the mass neoplastic, is it benign or malignant ?

If the mass is malignant, is it primary or metastatic ?


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Diagnosis of FNAB :

Influences management of the patients

(Zaijcek,1974;Kocjan et al ,1990; Orell, 1995) For example :

Benign lesion/neoplasms : surgicalintervention may be delayed or modified

Malignant neoplasms : prompt surgicaltreatment or irradiation


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Significant complication rare Kern (1998) : postaspiration necrosis in a case

of warthins tumor

Layfield et al (1992) : necrosisin a case ofpleomorphic adenoma Stephens et al (1999) : xantogranulomatous

following FNA of Warthins tumors Li et al (2000) and Mukunyadzi et al (2000)

review the histology Salivary glands lesionspreviously samples by FNAB : Infarction, necrosis, hemorrhage, inflammmation,

granulation tissue


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The primary objective :

Select the case :

Require surgery for neoplastic

Inflammmatory abnormality followed

clinically or treated medically

Aspiration biopsy

25 gauge needle

Larger caliber needles NOTRECOMMENDED (bleeding)


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Adequate/inadequate

Benign non neoplastic lesion

Cellular follicular lesion Hurtle cell neooplasm

Suspicious neoplasm

Malignant


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Adequacy of aspiration biopsy :

Six clusters of epithelial cells

Some centers do not agree case withpure colloid goiter ??

Depent of type of lesion (cystic or solid)

Ground glass appearance


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Ground glass appearance

PAPILLARY CARCINOMA OF THE THYROID

COURTESY OF PROF. SHOTARO MAEDA, NMS


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FOLLICULAR CARCINOMA OF THE THYROID

COURTESY OF PROF.S HOTARO MAEDA, NMS


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Triple diagnosis :

1. Clinical diagnosis

2. Radiology diagnosis3. Cytology/Histopathology diagnosis


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GIANT CELL TUMOR OF THE BONE


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GIANT CELL TUMOR OF THE BONE



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FNAB OF THE LUNG


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Janes and Spiro, AJRCCM 2007

ESTS, Deleyn P , Eur Cardio T Surg 2007 ACCP, Detterbeck F, Chest 2007

COURTESY OF DR. MAUD VESSELIC, LUMC

Radial vs Linear Endosonography (2)


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Radial vs Linear Endosonography (2)


Scopes and Ultrasound Processor


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Scopes and Ultrasound Processor


Transesopfageale echografie + naald punctie


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Transesopfageale echografie + naald punctie


Small cell lung carcinoma


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Small cell lung carcinoma

Syncytial group with nuclear molding and paranuclear cytoplasmic globules(so-called blue bodies)

Cells showing increasd cytoplasma that may be mistaken for non-small

cell carcinoma


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Immediately put the slide (after makesmear) into alcohol fixative 95% -96%minimally 30 minutes.

A part of slides let in the air until dry ( ifpossible use hairdryer or fan to makedry fast )

Dont forget to write down the patientlabel on the slide

Send to laboratory with form andcompletely clinical data


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The Role of FNAB (Fine Needle Aspiration

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