1. 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

2. Fine Needle Aspiration Biopsy / Fine Needle Aspiration Cytology
What is FNAB/FNAC ?
Fine Needle Aspiration Biopsy / Fine Needle Aspiration Cytology

3. FNAB/FNAC is a diagnostic procedure that uses thin (fine) needles ( <22-gauged ) to obtain tissue and cell samples Histological Diagnosis

4. Common Settings for FNAB/FNAC Diagnosis - Superficial lymph nodes - Breast lumps - Thyroid nodules - Salivary Tumours

5. Other Settings for FNAB/FNAC Diagnosis Deep Seated Tumours - Lung -Liver - Pancreas - Kidney

6. FNAB/FNAC Diagnosis Superficial tumour Deep lesions
Free-hand FNA by clinicians, Pathologists or others
Deep lesions
FNA under image-guidance

7. 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

8. 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.

9. 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

10. 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

11. 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 )

12. 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)

24. *** 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 )

26. THANK YOU
This provides several setting for potential errors.