FNAC

Noor Ullah

noor1.qau@gmail.com

Thursday, May 16, 2024

Fine Needle Aspiration Cytology(FNAC)

• Fine needle aspiration cytology refers to a procedure that obtains cellular

material for diagnosis using suction or non-suction techniques.
• Fine needle aspiration cytology may be performed on any body site that can be
reached with a fine needle.
• A fine or thin needle is defined as 22 or higher gauge.
• FNAC is a minimally invasive, cost-effective technique with high diagnostic
accuracy (90 to 99%).
• The aspirator should be aware of the relevant history and clinical information,
significant radiological studies and the clinical question that FNAC may answer.
• The procedure as well as the minor complications of bruising and bleeding
should be explained to the patient.
Equipment
1. Syringe: Depending on the site and lesion size 10 or 20 cc disposable plastic
syringe is used
2. Needle: Ordinary disposable hypodermic needle of 22–27 gauge is used for
FNAC.
• The size of the needle depends on the situation. Large bore needle is especially
helpful for hard and fibrotic lesions or cyst with viscous material.
• On the other hand thin bore needle is used for small lymph node or vascular
organ like thyroid
3. Clean glass slides: Frosted glass slides are preferable because they are easy to
be labeled
4. Spirit swabs: Clean sterile swabs soaked with spirit are needed to clean the
area of aspiration
Equipment

5. 95% ethanol for fixation of slide: This is needed to fix the slides for
Papanicolaou’s (Pap) stain

6. Few capped vials containing 10% formalin solution for cell blocks: Cell block is
needed to do immunocytochemistry on FNAC sample

7. Few capped vials containing balanced salt solution for transport of the
material in of case flow cytometry is needed.
Smear Preparation
• The material is pushed on the clean glass slide a little away from the corner.

• The direction of the needle should be along the long axis of the slide to avoid spillage of
the material sideways.

• Now the smear is made by gently pressing a clean glass slide over it and moving the
upper slide over the lower one to spread the material.

• Multiple smears are made and both air dried and alcohol-fixed smears should be kept for
staining.

• The residual material should be rinsed in balanced salt solution and can be processed for
ancillary techniques. If needed, a repeat FNAC should be undertaken to get more material
for the ancillary techniques
Smear preparation
Fine needle sampling (FNS)
• Fine needle sampling (FNS) is an alternative technique of FNAC and is helpful in
certain situations like thyroid swelling, breast lesions and small lymph nodes in a
child.
• In FNS procedure, no syringe is required during the procurement of the sample.
• The swelling should be pressed in between the two fingers and a thin bore needle
is gently introduced.
• The needle is moved to and fro in the same direction and also in small inclination
in different directions.
• The material comes to the hub of the needle by capillary pressure.
• The needle is gently withdrawn and the syringe filled with air is attached to the
needle hub.
• The aspirated material is expelled gently on the slide with the help of the syringe
Staining of the Smear
• Fixation: Air-dried smears are used for Giemsa staining.
• For routine Pap staining, 95% ethanol, methanol or isopropyl alcohol is used for
fixation.
• The smears should be fixed at least 30 minutes.
• Commercially available spray fixatives can also be used as an alternate to wet
fixation.
• The components of these spray fixatives are usually ethanol or isopropyl alcohol
along with polyethylene glycol (carbowax).
• Within a few seconds, the smear is dried and carbowax provides a covering over
the slide that prevents the shrinkage of the cell.
• Before staining, the smear should be dipped in ethyl alcohol for at least 15
minutes to remove the surface coating.
• In case of rapid Pap stain, only air dried smears are used.
Staining

• Air dried smear: Giemsa, Romanowsky stain or Diff-Quik stain is done on the air
dried smear.

• Wet fixed smear: On alcohol fixed smear, either Pap stain or hematoxylin and eosin
stain is used.

• One great advantage of Pap stain is to demonstrate intracellular keratin and thereby
identification of squamous cells.

• Rapid staining: Commercially available Diff-Quick stain can be used for rapid
staining within 2 minutes.

• Rapid Pap stain can also be done within 3 minutes.

References
• Diagnostic cytology by Pranab Dey