Fine Needle Aspirates

• Preferred method of obtaining samples from masses.

• Avoids superficial contamination
• Very little risk to patient
• Less complications to internal organs than core biopsy techniques
• Implantation of malignant cells along the aspiration tract is extremely rare
• Disadvantage: May not get a good sample because using just a small
needle.
FNAC
FNAC - definition

• Aspiration
• Non aspiration

• Aspiration : Aspiration of cells/ tissue fragments using fine needles (

22 , 23, 25 G) ; external diameter 0.6 to 1.0 mm
• 1.5 inches long needle ( radiologists use longer needles)
• 3-12 ml syringe
• Diagnostic materials in the needle and not in the syringe even in cystic lesions
FNA Aspiration Technique
• Hold mass/lymph node firmly
• Introduce the needle with syringe attached into the mass
• Apply strong negative pressure by withdrawing the plunger to about 2/3 -3/4 of the volume.
• Do several times in same area or redirect needle.
• Stop negative pressure and remove needle from mass
• Remove needle from syringe and air is drawn up into syringe
• Sample that is in hub of needle is expelled onto slide by rapidly depressing the plunger
• Hold needle close to slide, if too far away will result in small droplets that dry rapidly before
smear technique may be done.
FNA Non-Aspiration Technique
• Works best for small masses
that are difficult to aspirate.
• Works well for highly
vascular tissues
• Using a needle only, move
rapidly back and forth
(stabbing motion).
• Withdraw needle and place
syringe with air to force onto
slide.
Preparation of smears from aspirates
• Squash prep method
• Needle spread method
• Blood smear method
Squash Preparation
• With experience, can yield excellent cytologic smears
• Aspirated material is placed on the center of the slide
• A second slide is placed over the sample to form a cross.
• Carefully slide apart from first slide (Put down on and pick up to move).
• Do not place excessive downward pressure to the first slide because will cause
distorted ruptured cells
• The weight of the spreader slide is sufficient to adequately spread the cells.
Needle Spread Method
• Spread aspirate on the slide with tip of needle.
• Pull sample out into several projections (starfish appearance).
Blood Smear Technique
• Use if material is thick or fluid
• After material is expelled on
slide, second slide is held at
30-40˚angle.
• Second slide is pulled
backward until it contacts the
fluid
• Rapidly move forward like a
blood smear.
ADVANTAGES
• Fast - early diagnosis
• Less pain, less trauma
• No anaesthesia
• Acceptable by patients and doctors
• Accurate
Common Problems with FNA
• Few or no cells obtained
• Some lesions do not exfoliate cells well.
• The needle may miss the site of the lesion
• Timid collection
• Inadequate negative pressure
• Blood contamination
• Using too large needle gauge
• Prolonged aspiration
• Failure to blot if doing imprint
Common Problems with Preparation
• Poorly prepared slides due to thick or high cell numbers
• Allowing material to dry on slide before squash prep or other smear
technique.
• If a large amount of material is present, spread between two slides
• May have to do 4-5 slides form the same site in order to get valuable
diagnostic sample.
Staining Slides
• Diff-quik, Wright’s, Geimsa
• Papanicolau stains-
• used in human Ob/gyn exams. Stains nucleus and nuclear material better.
• New Methylene Blue stain
• Air dry these slides, do not heat fix.
• Use clean slides (make sure no lint on slide)
• Stain immediately after air drying
• Take care not to touch the surface of the slide or smear at any time.
Medical Terminology
• Hypertrophy-an increase in cell size and/or functional activity in
response to a stimulus.
• Hyperplasia- increase in cell numbers, via increased mitotic activity, in
response to a stimulus.
• Neoplasia- increase in cell growth and multiplication that is not
dependent on an external stimulus.
• Metaplasia- a reversible process in which one mature cell type is
replaced by another mature cell type (adaptive response to a
stimulus)
Medical Terminology Continued
• Dysplasia- reversible, irregular, atypical, proliferative cellular changes
in response to irritation or inflammation.
• Anaplasia- A lack of differentiation of tissue cells
• Less differentiated cells in a tumor is more malignant
• Chromatin pattern- the microscopic pattern of nuclear chromatin (the
chromatin pattern coarsens as malignant potential increases)