Download
1 / 26
260 likes | 313 Views
This informative guide discusses the Fine Needle Aspiration Biopsy (FNAB) and Fine Needle Aspiration Cytology (FNAC) diagnostic procedures. It covers the histological diagnosis and common settings for FNAB/FNAC in various conditions like superficial lymph nodes, breast lumps, thyroid nodules, and salivary tumors. The text emphasizes the importance of the right aspirationist, requesting clinician, and specimen quality for successful diagnosis, along with detailed techniques for specimen preparation and ancillary preparations. Learn about the essential components required for a successful FNAB/FNAC diagnosis.
E N D
Basic Diagnostic FNA for all – WY’s Approach Dr WY Lam Consultant Pathologist Department of Pathology Tuen Mun Hospital June 2018
What is FNAB/FNAC ? Fine Needle Aspiration Biopsy /Fine Needle Aspiration Cytology
FNAB/FNAC is a diagnostic procedure that uses thin (fine) needles ( <22-gauged ) to obtain tissue and cell samples Histological Diagnosis
Common Settings for FNAB/FNAC Diagnosis - Superficial lymph nodes- Breast lumps- Thyroid nodules- Salivary Tumours
Other Settings for FNAB/FNAC Diagnosis Deep Seated Tumours- Lung-Liver- Pancreas- Kidney
FNAB/FNAC Diagnosis Superficial tumour Free-hand FNA by clinicians, Pathologists or others Deep lesions FNA under image-guidance
Common Settings for FNAB/FNAC Diagnosis - Not all superficial lumps and bumps are candidates for FNA- Soft tissue tumours (Fibroma, lipoma, hemangioma etc) cannot & should NOT be investigated by FNA
1. THE RIGHT ASPIRATIONIST convinced of the usefulness of the technique skilled in palpation has mastered the technique performs an adequate no. of aspiration regularly for competency. A successful FNA Dx requires
2. RIGHT REQUESTING CLINICIAN knowledgeable on the INDICATIONS, CONTRA-INDICATIONS & LIMITATIONS of FNAC/B Technique Sound mind with JUDICIOUS SELECTION OF PATIENTS for the procedure - FNAC/B Dx begins with getting the RIGHT PATIENT A successful FNA Dx requires
3. Satisfactory QUALITY OF THE SPECIMENS & PREPARATION The sample has to be representative adequate in cellularity microscopically interpretative - no air drying / no obscuring clot / no thick overlapping aggregates / no crush artefact A successful FNA Dx requires
smear the tissue as in making a peripheral blood smear Fluid / Blood or Excess body tissue are rinsed for ancillary preparations ( Cytospin, LBC +/- CB ) The FNA Technique - Preparing the smears
Drop 4 smears QUICKLY ( < 2 sec after smearing ) into methanol wet fixation + *** 2 smears Dry in air All residual material to rinse into ancillary preservatives Visible fragments are picked for CB preparation, , or gently crushed to produce a monolayer smear ( AVOID EXCESSIVE PRESSURE to minimise *crushing) The FNA Technique - Preparing the smears
Cytospin preparation *** - rinse material into ALCOHOL-SALINE - recommended for ALL BREAST & LN FNA - Thinprep and Autocyte Prep monolayer Liquid Based Cytology ( LBC ) preparation as alternatives (expensive ) Cell block preparation ( = microbiopsy) - rinse residuum into FORMALIN - recommended in particular to THYROID, SALIVARY GLAND, AND ALL DEEP ORGAN FNA ( *** NOT X LN ) *** FNA Technique - Ancillary preparations
