FINE NEEDLE ASPIRATION CYTOLOGY(FNAC)-AN OVERVIEW

Prof. Tamal Kanti Ghosh MD

Medical 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. Barthalomew’s 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 mm Larger needles 80-120, 200mm (Transrectal/vag) Syringer holder Franzen handle Glass Slides Fixatives: 95% ethanol/ ether – alcohol 50:50

Method of aspiration

Position Examination Cleaning Fixing-mass Needle insertion Withdrawl of plunger To & fro movement Termination of aspiration Release of suction Application of pressure with fingers

Preparation of FNA smears

Wet fixed

Dry Fixed

STAINING H&E PAP MGG SPECIAL STAINING;

Alcian blue Mucicarmine,PAS} carbohydrate

Methyl violet,Congo red } Amyloid

Bacteria, Fungus

ASPIRATION FROM SPECIAL LESION/BODY SITES CYST THYROID LUNG PROSTRATE TESTIS ABDOMINAL FAT- PARA UMBILICAL FOR

AMYLOIDOSIS GUIDED FNAC -USG, CT

Microbiological studyCell BlockImmunocytochemical studyImage analysis & morphometryFlow cytometryUltrastructural studiesMol Biology Tech

COMPLICATIONS & HAZARDS OF FNAC HAEMATOMA INFECTION PNEUMOTHORAX DESSEMINATION OF TUMOR VASOVAGAL ATTACK

PRECUTIONS & CONTRAINDICATIONS BLEEDING DISORDER LIVER FNA- P Time (PTI >80%)/OBST

JAUNDICE LUNG- EMPHYSEMATOUS/ PULMO

HYPERTENSION PANCREATITIS ADRENAL TUMOR-

PHEOCHROMOCYTOMA

LIMITATIONS

SMALL NO OF CELL POPULATION IN SAMPLE

ADEQUACY LACK OF CLINICAL DATA ARTIFACTS