Department of Pathology Basic Diagnostic FNA for all – WY’s Approach Dr WY Lam Consultant Pathologist Department of Pathology Tuen Mun Hospital June 2018 nhkjhoiulihoinbkib

Fine Needle Aspiration Biopsy / Fine Needle Aspiration Cytology 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 Deep lesions 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

A successful FNA Dx requires 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

The FNA Technique - Preparing the smears 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)

*** FNA Technique - Ancillary preparations 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 )

THANK YOU This provides several setting for potential errors.