Fine Needle Aspiration Cytology (FNAC) of the Lymph Node

Fine Needle Aspiration Cytology (FNAC) is a minimally invasive diagnostic procedure that extracts cells or tissues from a lymph node using a thin, hollow needle for microscopic examination. Lymph nodes are small, bean-shaped structures that are integral to the body’s immune system and filter lymph, a clear, watery fluid-carrying immune cells.

Dr Jesse Hu
Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

When is the FNAC of the Lymph Node Needed?

FNAC of the lymph node is typically recommended under specific circumstances that indicate potential health issues. The procedure becomes necessary when changes in the lymph nodes, such as enlargement, persist without an obvious cause related to common infections. Here are the key scenarios where FNAC is particularly useful:

Persistent Lymphadenopathy

This refers to swelling of the lymph nodes that lasts longer than expected for typical infections, raising concerns about underlying health conditions.

Evaluation of Known Malignancy

FNAC is used to ascertain whether cancer from another part of the body has spread to the lymph nodes.

Diagnosis of Primary Lymph Node Diseases

Conditions such as lymphoma, which originate in the lymphatic system, can be identified through FNAC.

Investigation of Systemic Conditions

Diseases that affect the entire body, like autoimmune disorders, often impact lymph nodes and can be evaluated using this procedure.

Benefits and Risks of FNAC of the Lymph Node

Minimally Invasive: FNAC involves using a fine needle, making it less invasive than surgical biopsies, resulting in minimal discomfort and scarring.

Quick and Efficient: The procedure is relatively quick, often completed within minutes, and requires no hospital stay, allowing for efficient diagnosis and minimal disruption.

Highly Informative: It provides valuable information about the nature of lymph node abnormalities, aiding in diagnosing infections, inflammatory conditions, and cancers.

Cost-Effective: Being less complex than surgical biopsy, FNAC is generally more cost-effective, making it accessible for more patients.

Limited Tissue Sample: The small size of the needle limits the amount of tissue that can be collected, which may sometimes result in the need for additional tests.

Potential for Inconclusive Results: There is a risk of obtaining non-diagnostic or inconclusive results, requiring further investigation through more invasive procedures.

Infection Risk: As with any procedure that breaks the skin, there is a small risk of infection at the needle insertion site.

Bleeding Complications: While rare, bleeding can occur, especially in patients with bleeding disorders or those on blood thinners.

Preparing for FNAC of the Lymph Node

Preparation for FNAC of the lymph node involves a few straightforward steps to ensure the procedure’s safety and effectiveness. Patients should adhere to the following guidelines:

  • Medical History Review: It is important to inform the thyroid specialist about any existing medical conditions, allergies, medications, or supplements being taken, especially blood thinners, which may need to be adjusted prior to the procedure.
  • Fasting Not Typically Required: While fasting is generally not necessary for FNAC, specific instructions might be given depending on the patient’s overall health or if additional procedures are planned.
  • Comfortable Clothing: Opting for clothing that provides easy access to the area where the lymph node is located can facilitate a smoother procedure.

The FNAC Procedure

The FNAC procedure for lymph nodes is a quick, typically outpatient process, designed to collect cells for examination with minimal discomfort. The following outlines the main steps involved:

  • Skin Cleaning: The skin over the lymph node is cleaned with an antiseptic solution to minimise infection risk.
  • Local Anaesthesia: Although not always necessary, local anaesthesia may be administered to numb the area and reduce discomfort.
  • Needle Insertion: A fine needle, attached to a syringe, is gently inserted into the lymph node. The practitioner may use ultrasound guidance to place the needle accurately.
  • Aspiration: The thyroid specialist applies gentle suction with the syringe to collect cells from the lymph node.
  • Withdrawal of the Needle: The needle is carefully withdrawn once sufficient cells are collected. The procedure usually lasts just a few minutes.
  • Sample Preparation: The aspirated material is expelled onto glass slides, smeared, and then fixed or air-dried for staining. This prepares the samples for microscopic examination.
  • Pressure Application: A small bandage is applied to the needle insertion site. Applying pressure helps to minimise bleeding and reduce bruising.

Postoperative Care and Recovery

After undergoing FNAC of the lymph node, postoperative care is minimal, emphasising the procedure’s non-invasive nature. Patients can generally expect a quick recovery with minimal complications. Here are the key points for postoperative care:

Site Care

The puncture site should be kept clean and dry for at least 24 hours after the procedure. Any bandage or dressing can be removed the next day.

Observation for Complications

While significant complications are rare, patients should monitor for signs of infection such as increased redness, swelling, warmth, or discharge at the puncture site. Fever or persistent pain should also prompt a consultation with a thyroid specialist.

Activity Resumption

Patients can typically resume their regular activities immediately after the procedure. However, it is advisable to avoid strenuous activities for a short period if recommended by the thyroid specialist.

Follow-Up

A follow-up appointment is often scheduled to discuss the results of the cytology analysis. This is an important step to determine the next steps in management or treatment based on the FNAC findings.

Dr Jesse Hu

Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

Dr Jesse specialises in managing both benign and malignant breast and thyroid conditions, which also includes breast pain, breast lumps, breastfeeding problems, neck lumps, amongst others.

Her dual expertise in cancer removal and plastic surgery techniques expands the design of individualized treatments, leading to holistic patient outcomes.

Dr Jesse was part of the teaching faculties of both NUS Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine, where she teaches and mentors the next generation of medical students and trainee doctors.

  • Surgical training at NUS School of Medicine
  • FRCS (Fellow of the Royal College of Surgeons) Edinburgh, UK in 2014
  • Completed 2 Health Manpower Development Program (HMDP) fellowships at Oxford University Hospital, UK in 2016

Dr Jesse is recognized as an authority in breast cancer and thyroid surgery and a sought-after conference speaker.

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    Fine Needle Aspiration Cytology (FNAC) of the Lymph Node

    Frequently Asked
    Questions

    What Conditions Can FNAC of the Lymph Node Diagnose?

    FNAC is adept at diagnosing various conditions such as bacterial or viral infections, autoimmune diseases, and benign and malignant tumours, including lymphomas and metastatic cancers. This technique is invaluable for investigating lymph nodes that have changed in size or texture without a clear cause, providing early detection and characterisation of potentially serious conditions.

    Is the FNAC Procedure Painful?

    FNAC is generally associated with minimal discomfort, akin to a brief, sharp sensation, largely mitigated by the application of local anaesthesia at the needle insertion site. The procedure’s swift nature, often completed within a few minutes, further limits any discomfort experienced by the patient.

    How Long Does It Take to Get Results from an FNAC?

    Typically, FNAC results are available within 3 to 5 days, although this timeline can vary depending on the analysis’s complexity and the diagnostic laboratory’s specific policies. Expedited processing is sometimes possible for urgent cases, facilitating quicker decision-making in managing potentially serious conditions.