FINE NEEDLE ASPIRATIONCYTOLOGY(FNAC)-AN OVERVIEW Prof. Tamal Kanti Ghosh MD Medical superintendent –Cum- Vice Principal. School of Tropical Medicine, Kolkata FNAC Sample of cells aspirated from suspicious mass for diagnostic purpose-material converted to cytological sample for microscopic examination HISTORY FNAC dates back to 19th Century St. Barthalomew’s Hospital-Surgeon Stanley & Earle - Aspiration from Liver St.Paget advocated aspiration in lumps Menetier- 1st Lung ASPIRATION Greigg& Gray - 20th Century beginning – L. Nodes in trypanosomiasis Gutherei -1921-first to use 21 g needle Martin . 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 & specificity Fear of tumor implantation along the tract Apprehension of lawsuits Reluctance . palpable abdominal lesions testicles. other accessible sites prostrate. bones . pelvic organs. salivary gland. joints & lung .FNAC Application: Diagnosis of palpable lesion Breast. superficial soft tissue mass. thyroid. FNAC : Advantages FNAC OPD procedure Minimal invasive cost effective No anaesthesia Rapid safe & painless Multiple /repeated attempt possible No fibrosis Definitive diagnosis in inoperable cases Rapid Diagnosis . 200mm (Transrectal/vag) Syringer holder Franzen handle Glass Slides Fixatives: 95% ethanol/ ether – alcohol 50:50 .25-20 g 38mm(l)0.10/ 20 ml Needle .Procedure : Materials : Syringe.9mmin ext diameter. Std 21 g 38 mm Larger needles 80-120.6-0. . . 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 . Congo red } Amyloid Bacteria.PAS} carbohydrate Methyl violet. Fungus .STAINING H&E PAP MGG SPECIAL STAINING. Alcian blue Mucicarmine. . PARA UMBILICAL FOR AMYLOIDOSIS GUIDED FNAC -USG.ASPIRATION FROM SPECIAL LESION/BODY SITES CYST THYROID LUNG PROSTRATE TESTIS ABDOMINAL FAT. CT . . . . . . . . . . . . . . . . . . . Microbiological study Cell Block Immunocytochemical study Image analysis & morphometry Flow cytometry Ultrastructural studies Mol Biology Tech . COMPLICATIONS & HAZARDS OF FNAC HAEMATOMA INFECTION PNEUMOTHORAX DESSEMINATION OF TUMOR VASOVAGAL ATTACK . P Time (PTI >80%)/OBST JAUNDICE LUNG.PRECUTIONS & CONTRAINDICATIONS BLEEDING DISORDER LIVER FNA.EMPHYSEMATOUS/ PULMO HYPERTENSION PANCREATITIS ADRENAL TUMORPHEOCHROMOCYTOMA . LIMITATIONS SMALL NO OF CELL POPULATION IN SAMPLE ADEQUACY LACK OF CLINICAL DATA ARTIFACTS .