1. Introduction of Fine Needle Aspiration (for cytotechs) By Dr May Yu 3rd August 07

2. FNA- Use and Indications Diagnosis – First, follow up to assess therapy response, recurrence, staging Obtain tissue for other tests: e.g. cultures, biochemical tests (rare), molecular studies (uncommon in our lab). Therapeutic – e.g. cyst compressing vital structures

3. FNA procedures In FNA clinics of pathology department Radiological guided e.g. CT, ultrasound, endoscopic ultrasound

4. FNA procedures Tools for FNA –Suction retractors –Syringes –Fine needles –Glass slides –Fixatives –Sterile material –+/- culture bottles

5. FNA procedures Precautions for patients –Sterile to avoid contamination or cross- infection. –Control bleeding: adequate hemostasis by direct pressure of puncture site, avoid FNA on patients with bleeding tendency, avoid vessels – Avoid vital structures or puncturing trachea, pleural space.

6. FNA procedures Precautions for staff - questionaire to assess patients ’ risk - avoid cross-infection: masks, gloves, eye- shield, safety cabinents, avoid smearing cases with high risk of infection, adequate fixation before further processing of these cases. - avoid needle injury

7. FNA procedures For superficial procedures - usu no anasethesia needed For deep seated procedures +/- sedation or local anaesthesia.

8. FNA sites Superficial: palpable lesions –Lymph nodes, thyroid nodules or cysts, skin or subcutaneous nodules/cysts, salivary nodules/cysts, breast lumps/cysts, enlarged liver masses. Deep seated – usually need CT, ultrasound, or endoscopic ultrasound guidance –Deep seated lymph nodes, masses/nodules/cysts. e.g. lung, mediastinal, intra-abdominal, pelvic, retroperitoneal

9. Examples of FNA Lymph node Thyroid Salivary gland Breast