Fine Needle Aspiration Cytology

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Fine Needle Aspiration Cytology

• Acharya Ganesh
• Cytotechnologist
• Maternity hospital
• Thapathali
• Kathmandu

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General consideration

• The purpose of FNA is to obtain diagnostic
  material for cytological study from organs that
  do not shed cells spontaneously. The bone marrow,
  spleen, liver, breast, thyroid gland, and lymph
  nodes are typical targets of this diagnostic
  procedure.
• Sampling of tumors by means of narrow gauge
  needle was first described in 1930 in USA and
  became popular in late 1950s.
• Sophisticated radiological imaging, computed
  tomography (CT), ultrasonography (USG), and image
  intensified fluoroscopy have been added to this
  method to perform FNA more accurately and
  precisely.

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Clinical skills required

• Aspiration biopsy may be indicated whenever there
  is a palpable tumor mass or a lesion is
  visualized within any organ. For the physician
  using this procedure, some familiarity with
  general anatomy is essential. For the pathologist
  performing aspiration , a review of general
  anatomy may be required, as well as sharpening
  the skills needed to perform physical examination
  and take the focused clinical history. The
  cytopathologist must also have knowledge of
  normal cell elements from a variety of organs and
  tissues as they appear in smear.
• Medical Technologist may be quite helpful with
  the aspiration service, ensuring that the smears
  are prepared and fixed and materials for cell
  block, immunocyto- or histochemistry or EM, as
  well as other specialized techniques handled
  appropriately.

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Types of FNA

• There are so many methods of aspiration using
  advanced technology which are specified
  organ-wise.
• In conventional methodology two popular
  techniques are described Transcutaneous and
  Transrectal aspiration biopsy, for the diagnosis
  of lesions from the palpable mass and lesions of
  the prostate, ovary, etc.

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MATERIALS REQUIRED

• Needle 21 G / 23 G
• Disposable syringe 10 - 20 ml.
• New glass slides
• Syringe handle (franzen)
• 80 propanol
• Coplin jar
• Spirit swab
• Reports of coagulogram (PT)
• Cotton gauge/ Dry swab
• Adhesive tape.
• Pencil
• Tooth picks
• Waste disposable containers (Blood stained
  products, non stained products)
• FNAC reporting form.
• Bed
• Table
• Tray for carrying the slides.

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Preparation of smears

• PROCEDURE
• Principle
• The negative pressure created within the syringe
  by aspiration holds the tissue against the sharp
  cutting edge of the needle so that tissue will be
  cut by the cutting end of needle and accumulates
  within the lumen of the needle/ syringe tip.

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• Put the clean glass slides on the table.
• Fill the coplin jars with 80 propanol.
• Explain the procedure to the patient and get the
  written consent.
• Place the patient on the aspiration table in
  supine position or any position which will expose
  the desired aspiration site.
• Expose the aspiration site
• Clean the site with spirit swab from center
  outwards in concentric fashion
• Leave area to dry.
• Open the syringe from the plastic wrapper fix
  the needle to the syringe tip.

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• 9. Check the syringe by aspirating, air in out
  of the syringe, put the needle in the needle
  holder.
• 10. Prick the lump by vertical technique, in
  which the needle is perpendicular to the skin.
• 11. Aspirate the lump by pulling the piston,
  Rotate the needle and continue to aspirate. Move
  the needle back and forth and aspirate.
• 12. If the lump is big change the direction of
  the needle and again aspirate.
• 13. If the lesion is huge, multiple sites
  aspiration may be needed.

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• 14. Stop the aspiration. Let the piston go to its
  resting position. Withdraw the needle.
• 15. Put a dry swab/ cotton gauze over the
  aspiration site and put an adhesive tape. Ask the
  patient to press the site for 5-10 min.
• 16. Put a drop of aspirate on the surface of a
  clean glass slide 2 cm away from the end of
  slide.
• 17. Immediately, spread the material on the slide
  by holding the slide with one hand and putting
  the flat surface of an another glass slide over
  the material and move it smoothly, gently and
  swiftly to the other end of the slide by applying
  gentle pressure.

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• Slides planned for Papanicolaou stain are
  subjected into the 80 propanol so that the
  aspirated material is totally submerged in the
  alcohol solution.
• Slides planned for Giemsa stain are left to dry
  in open air.
• Slides planned for immunocyto or histochemistry
  should be prepare in pretreated (albumenized)
  slides or pre-coated adhesive slides prepared for
  the designated techniques.

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DOCUMENTATION

• Date on which the tests done
• Fixative used for wet smear
• Gross finding e.g Mobile, Firm, well defined
  lump, size (e.g, 22 cm).
• Name of Pathologist/Physician/Radiologist
  performing the test
• Name of Laboratory personnel assisting
• Clinical diagnosis.
• Transfer the slides to the staining table in
  cytopathology laboratory.
• Transfer the documented records to the reporting
  pathologist cytopathology register.
• Date of preparation of 80 propanal

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Internal Quality Control Procedures

• Grease free and clean slides should be used.
• A good quality 10 ml. or 20 ml. syringe should
  be used to create sufficient negative pressure to
  aspirate tissue.
• An experienced technologist or Laboratory
  personnel should perform the staining procedure.

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Fixatives and stains

• Dried smear are stained by Romanowsky staining
  method, especially May Grunwald- Giemsa or its
  variation like Diff-quick stain.
• Other stains can be applied according to the need
  of diagnosis e.g. Grams, Z. N. stain, PAS,
  Alcian blue stain.
• Wet fixed smear by Papanicolaou stain.
• 1.5 glutaraldehyde fixative solution for EM
  study.
• Specialized techniques are applied on immuno
  cytochemistry or histochemistry for cancer marker
  test.

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Comparison of air dried and wet fixed smear
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Complication of FNAC

• FNA is considered one of the safest invasive
  diagnostic procedures though complications were
  estimated at 0.03 of cases.
• Complications of the FNAC of superficial masses
  include needle track seeding pneumothorax with
  breast, axillary, and supraclavicular masses,
  transient acute swelling (thyroid) hematomas, and
  histological alterations.
• More serious and sometimes life-threatening
  complications may occur with aspiration of deep
  organs. In the chest, these includes
  pneumothorax, massive hemorrhage, air embolism,
  and tamponade.
• Risk factors to be considered that may influence
  the development of complications following FNA
  are patients age and sex, presence of underlying
  disease, and bleeding disorders.
• Also exerting influence on the rate of
  complications are location, size, and the depth
  of the mass needle size number of passes and
  the level of experience of the aspirator.

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Comparison
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Namaskar