fine needle aspiration cytology(fnac)-an overview.ppt
TRANSCRIPT
FINE NEEDLE ASPIRATION CYTOLOGY(FNAC)-AN OVERVIEW
Prof. Tamal Kanti Ghosh MD
Medical superintendent –Cum- Vice Principal.
School of Tropical Medicine, Kolkata
Sample of cells aspirated from suspicious mass for diagnostic purpose-material converted to cytological sample for microscopic examination
FNAC
HISTORY
FNAC dates back to 19th Century St. Barthalomew’s Hospital-Surgeon Stanley & Earle - Aspiration from LiverSt.Paget advocated aspirationin lumpsMenetier- 1st Lung ASPIRATIONGreigg& Gray - 20th Century beginning – L. Nodes in trypanosomiasis
Gutherei -1921-first to use 21 g needleMartin , Ellis & Stewart First large scale study of 2500cases using 18 g needle
Zajicek of Karolinska Hospital Stockholm – FNAC to international attention in 1980s till than not used because :Lack of confidence in sensitivity & specificityFear of tumor implantation along the tractApprehension of lawsuitsReluctance
FNAC
Application:Diagnosis of palpable lesionBreast, thyroid, superficial soft tissue mass, salivary gland, palpable abdominal lesions testicles, other accessible sites prostrate, pelvic organs, bones , joints & lung
FNAC : Advantages
FNAC OPD procedureMinimal invasivecost effectiveNo anaesthesiaRapid safe & painlessMultiple /repeated attempt possibleNo fibrosisDefinitive diagnosis in inoperable casesRapid DiagnosisAspirator-Reporter
Procedure :
Materials : Syringe- 10/ 20 ml Needle - 25-20 g 38mm(l)0.6-0.9mmin ext
diameter, Std 21 g 38 mm Larger needles 80-120, 200mm (Transrectal/vag) Syringer holder Franzen handle Glass Slides Fixatives: 95% ethanol/ ether – alcohol 50:50
Method of aspiration
Position Examination Cleaning Fixing-mass Needle insertion Withdrawl of plunger To & fro movement Termination of aspiration Release of suction Application of pressure with fingers
STAINING H&E PAP MGG SPECIAL STAINING;
Alcian blue Mucicarmine,PAS} carbohydrate
Methyl violet,Congo red } Amyloid
Bacteria, Fungus
ASPIRATION FROM SPECIAL LESION/BODY SITES CYST THYROID LUNG PROSTRATE TESTIS ABDOMINAL FAT- PARA UMBILICAL FOR
AMYLOIDOSIS GUIDED FNAC -USG, CT
Microbiological studyCell BlockImmunocytochemical studyImage analysis & morphometryFlow cytometryUltrastructural studiesMol Biology Tech
COMPLICATIONS & HAZARDS OF FNAC HAEMATOMA INFECTION PNEUMOTHORAX DESSEMINATION OF TUMOR VASOVAGAL ATTACK
PRECUTIONS & CONTRAINDICATIONS BLEEDING DISORDER LIVER FNA- P Time (PTI >80%)/OBST
JAUNDICE LUNG- EMPHYSEMATOUS/ PULMO
HYPERTENSION PANCREATITIS ADRENAL TUMOR-
PHEOCHROMOCYTOMA