INTRODUCTION TO FINE NEEDLE
ASPIRATION CYTOLOGY (FNAC)
Harniyatie binti Mohamad
Describe the role of cytotechnologist in
assisting FNA procedure.
Learning Discuss general FNAC procedure and
Outcome various types of FNAC specimens.
Perform FNAC specimen processing.
Before- Preparation of reagent and
equipments for FNAC clinic
Role of cytotechnologist in During-Specimen preparation, rapid stain,
FNAC procedure. on-site evaluation of adequacy
Lecture After- Staining, cell block, ancillary test
outlines
Common site of FNAC.
Describe general FNAC
procedure and various types of
FNAC specimens.
Procedure FNA (Palpable, non-palpable)
and sample processing.
INTRODUCTION
A technique whereby cells are obtained from a lesion using a
thin bore needle and smears are made for cytopathological
diagnosis.
Fine needle aspiration cytology (FNAC) is a major area of
cytology.
Used in diagnosis of breast lumps, thyroid nodules, liver
disease, subcutaneous soft tissue mass, salivary gland
diseases and oral diseases.
Principles
The negative pressure created 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 / syringetip
2. 3. Smear 4.
1. Palpation
Aspiration preparation Microscopy
Advantages of FNAC procedure
Does not require
Simple, rapid & Multiple area of High sensitivity any anaesthesia or
cheap sampling and specificity special
precautions.
Ancillary
techniques
possible on FNAC
sample
Advantages of FNAC procedure
No need for initial
Patient privacy is No scars on the There is no risk
preparation (eg:
protected suture container from anesthesia
diets)
The procedure No need to enter
does not require the ward (most
large costs cases)
Roles of cytotechnologist in FNAC procedure
Before procedure
• Prepare reagents and equipments
During procedure
• Ensure FNA material is taken at the correct organ from the correct patient.
• Make sure the slides are labeled correctly.
• Ensure FNA cases are properly isolated
• Ensure the test request form has been completed
• Ensure patient understand and fill consent form
• Ensure the handling of aspirated samples such as: smearing, quick stain, air dried smear and
wet fixed smears as well as cell block preparation is done perfectly.
• Check sample adequacy (>10 clusters of 6-10 cells)
• Preparation of specimens for culture, IHC
After procedure
• Staining (in lab), prepare samples for ancillary testing: eg cell block
FNAC tools and procedure
21 or 23G
10 or 20ml A syringe
needles with Glass slides Alcohol swab
syringe holder (cameco)
1.5’ length
95% alcohol for Cell block tubes
Diff quick Sterile
fixation (spray Microscope containing 10%
solutions containers
fix) formalin
Disposable Stationaries,
Spirit and
Slide trays Gloves container/ eg: pencil,
swabs
Sharp bin eraser, etc
FNAC procedure
Clinical History Preparation of the Patient
• The following information are • The following measures may help
mandatory before FNAC: during preparation of the patient:
• Exact site of swelling • Explain the whole procedure in brief.
• Size of the lesion • Take proper consent from the
• History of previous FNAC patient particularly for FNAC of
• Any bleeding disorder deep-seated lesions.
• Talk with the patient and give
assurance to make him/her relax.
• Clean the area of the site of FNAC
with a spirit swab.
FNAC procedure
Take the pistol Gently introduce
The Immobilize the
handle with the needle and
cytopathologist swelling by two
attached plastic move the needle
should personally fingers of one of
syringe and to and fro in the
perform FNAC. your free hands.
needle. mass.
Apply firm
Apply negative Lastly, release of
pressure in the
suction by the plunger to Withdraw the
site of FNAC to
withdrawing the stop negative needle.
stop any
plunger. suction.
bleeding.
Retract the
plunger to get Reattach the Eject the material
enough air within needle. on the slide.
the syringe.
FNAC
FNAC TOOLS AND tools and procedure
PROCEDURE
FNAC tools and procedure
FNAC tools and procedure
Retrieving FNA material
• The obtained samples were placed on a
clean slide using a syringe
• All materials taken must be processed as
best as possible
• If the material taken is trapped in the
hub, do whatever it takes to remove the
material without damaging the cell.
• Rinse the material attached to the hub
with saline or fixative
• Use another needle to inhale the cells
attached to the hub
Slide preparation and on-site staining
Air dried
smear
Diff quick
staining
To prepare:
1. Air dried smear
2. Wet smear
Cellularity assessment and pre-diagnosis
➢ Bed-site diff quick staining are
performed to assess cellular adequacy
➢ Should be done rapidly
➢ Ask doctor to get more material if
unsatisfactory
➢ Pre-diagnosis only done if there is
pathologist/ cytopathologist on site
FNA (superficial mass)
• Breast
• Thyroid
• Lymph node
• Salivary gland
Types of • Other superficial lumps
FNAC FNA ( deep-seated mass)
• Gastrointestinal tract
specimen • Pancreas
• Lung
• Liver
• Kidney
• Others
1. FNAC FROM SUPERFICIAL MASS
(PALPABLE)
Aspiration technique N0n-aspiration technique
a fine needle is
inserted into the target
Cells from lump lump to remove the
are taken out by tissue without using a
using needle syringe until a sample
and syringe produced is visually
seen on the hub of the
needle
2. FNAC (NON PALPABLE)/ DEEP-SEATED
MASS
The common types of guidance of
deep-seated FNAC include:
❖Ultrasonography (USG)-guided
FNAC
❖Computerized tomography (CT)-
guided FNAC
❖Endoscopic ultrasound-guided
FNAC (EUS-FNAC)
❖Mammographic-guided FNAC
❖Fluoroscopy-guided FNAC
❖Magnetic resonance image (MRI)
guidance
PROCESSING OF FNAC SAMPLES
Microscopic
Air dried – MGG
examination by
Slides staining
cytopathologist
1. Air dried
2. Wet smear Microscopic
Wet smear – Pap
examination by
stain
cytopathologist
Samples
received in Microscopic
Process as non-
laboratory Cyst fluid examination by
gynae
cytopathologist
Process for cell Microscopic
Material for cell
block and send to examination by
block histopathology lab cytopathologist
THANK YOU
