**4. Fine needle aspiration cytology**

Fine needle aspiration biopsy or cytology is an effective tool in evaluating and diagnosing suspect lumps or masses. The name indicates this biopsy technique uses aspiration to obtain cells or fluid from a superficial or deep palpable mass. A quick diagnosis means that tumor is detected early, or benign lumps are diagnosed without the need for multiple surgeries [4]. The success of perfect FNAC depends on the technique for collection and preparation of samples along with a detailed clinical history and clinical impression. If an infectious process is suspected, often a portion of the specimen is submitted for microbiology in an appropriate sterile medium or transport container.

FNAC is indicated in head and neck lesions, which include salivary gland lesions, thyroid and parathyroid lesions, cervical lymph nodes and intraosseous lesions.

#### **4.1 Collection: preparation for FNAC**

Alcohol wipe; 4 × 4-inch gauze pads; 10-ml plastic syringes; 25-gauge 1 1/2-inch stiff, noncutting, bevel-edged needles; glass slides; alcohol bottles; pistol-grip mechanical syringe holder.

#### **Procedure:**


**51**

*Methods of Collection and Transport of Materials to Laboratory from Oral and Dental Tissue…*

9. Multiple short 5-mm "in-and-out" motions are made till tissue material is seen

10. At first appearance of any sample at junction, the syringe pistol is released, letting the vacuum equate to normal, and the needle is withdrawn slowly.

12.The above procedure can be repeated again using a clean needle for a second

The needle is removed quickly from the syringe. Five milliliters of air is aspirated into the syringe, and the needle is placed back on the syringe. With the needle bevel facing down, 1–2 drop of aspirated material is expelled onto each of several

*Preparation of smear:* A drop of aspirate is placed at the center of plain glass slide. A second slide is inverted over the drop, and the slides are gently pulled apart vertically or horizontally once. Fix immediately in 95% ethyl alcohol for a wet smear. For studying and evaluating cytoplasmic features or background elements of smear, air drying is preferred. Until all the material in the needle is used, continue making more slides. Or a drop is placed near the frosted end of slide held in the left hand; the bloody material is spread along the edge of the slide held in the right hand. The material is pulled gently down the slide in a manner of making a blood smear.

Alternatively the expressed specimen is sent directly to the laboratory in a 50% ethyl alcohol fixative or Hank's balanced salt solution for slide preparation. If a cyst

1.Often needle biopsy without aspiration based on capillary pressure in a fine needle is sufficient to keep the scraped cells inside the lumen. A 25-gauge needle is held directly with finger tips and is inserted into the target lesion and is moved back and forth in various directions. This procedure offers the advantage of better feel of tissue consistency and less admixture of blood and

2.Cell block preparation: It refers to formalin fixing and paraffin embedding of aspiration biopsy that help reinforce some tissue patterns that may be seen on smears—aids in specific diagnosis especially for immunoperoxidase

3.Flow cytometry, electron microscopy and molecular diagnostic studies such as

Causes for rejection: Improper labeling, improper fixation and air-drying artifact.

The cervical and supraclavicular lymph nodes of the neck are in the drainage path of many infectious and malignant diseases; an examination should be made by

ELISA and FISH can be performed on FNAC specimens.

Storage instructions: Refrigerate in a fixative if there is delay.

**5. Collection of specimen from cervical lymph nodes**

is aspirated, the laboratory will have to spin the specimen for concentration.

11. Pressure is applied to the puncture site with sterile gauze pad.

*DOI: http://dx.doi.org/10.5772/intechopen.92677*

coming into the hub of the needle.

pass (and more passes if needed).

marked glass slides.

Modifications:

is valuable for tiny lymph nodes.

cytology staining.

**4.2 Preparing the aspirate: making direct smears**


## **4.2 Preparing the aspirate: making direct smears**

The needle is removed quickly from the syringe. Five milliliters of air is aspirated into the syringe, and the needle is placed back on the syringe. With the needle bevel facing down, 1–2 drop of aspirated material is expelled onto each of several marked glass slides.

*Preparation of smear:* A drop of aspirate is placed at the center of plain glass slide. A second slide is inverted over the drop, and the slides are gently pulled apart vertically or horizontally once. Fix immediately in 95% ethyl alcohol for a wet smear. For studying and evaluating cytoplasmic features or background elements of smear, air drying is preferred. Until all the material in the needle is used, continue making more slides. Or a drop is placed near the frosted end of slide held in the left hand; the bloody material is spread along the edge of the slide held in the right hand. The material is pulled gently down the slide in a manner of making a blood smear.

Alternatively the expressed specimen is sent directly to the laboratory in a 50% ethyl alcohol fixative or Hank's balanced salt solution for slide preparation. If a cyst is aspirated, the laboratory will have to spin the specimen for concentration.

Modifications:

*Oral and Maxillofacial Surgery*

negative result.

**4. Fine needle aspiration cytology**

**4.1 Collection: preparation for FNAC**

mechanical syringe holder.

tient's cooperation.

and easily graspable.

**Procedure:**

e.Recurrence can be known very easily without taking biopsy.

nique called fine needle aspiration cytology (FNAC) is used.

f. Mainly used for ulcerative epithelial lesion; intact epithelium gives false

g.Also used for dermatological condition like pemphigus vulgaris, Darier's

disease, and viral infections like herpes simplex as well as aphthous ulcers, etc.

Fine needle aspiration biopsy or cytology is an effective tool in evaluating and diagnosing suspect lumps or masses. The name indicates this biopsy technique uses aspiration to obtain cells or fluid from a superficial or deep palpable mass. A quick diagnosis means that tumor is detected early, or benign lumps are diagnosed without the need for multiple surgeries [4]. The success of perfect FNAC depends on the technique for collection and preparation of samples along with a detailed clinical history and clinical impression. If an infectious process is suspected, often a portion of the specimen is submitted for microbiology in an appropriate sterile medium or transport container. FNAC is indicated in head and neck lesions, which include salivary gland lesions,

thyroid and parathyroid lesions, cervical lymph nodes and intraosseous lesions.

stiff, noncutting, bevel-edged needles; glass slides; alcohol bottles; pistol-grip

2.For head and neck biopsies, a chair with head rest is essential.

tempt to determine the location and surrounding tissue.

7.The needle is inserted quickly and advanced into the mass.

very anxious patients or for deep biopsies.

at determined puncture site and angle.

1.Explanation of procedure to the patient before doing FNAC ensures the pa-

3.Prebiopsy sedation is usually not required, except in the deep aspirations in

4.The patient is placed in a comfortable position—with mass readily palpable

5.The lesion is grasped with one hand usually between two fingers with an at-

6.The syringe pistol with attached needle is laid against the surface of the lesion

8.The suction is applied to syringe, about one third the length of syringe barrel observing the junction of the hub and needle for appearance of any specimen.

Alcohol wipe; 4 × 4-inch gauze pads; 10-ml plastic syringes; 25-gauge 1 1/2-inch

Deeper lesions are not identified by this technique, and for that another tech-

**50**


Storage instructions: Refrigerate in a fixative if there is delay. Causes for rejection: Improper labeling, improper fixation and air-drying artifact.
