Fine needle aspiration is also called fine needle biopsy is a technique that allows a biopsy of various bumps and lumps. Fine needle aspiration is a test done to see if a tumor is benign (noncancerous) or malignant (cancerous).
Definition
Fine needle aspiration (FNA) in pediatrics is a minimally invasive diagnostic procedure used to evaluate lumps, lymph nodes, or masses—especially to distinguish between benign and malignant lesions. It is safe, quick, and often performed with minimal discomfort.
Purpose of Pediatric FNA
- Cytological diagnosis of palpable or image-guided masses
- Evaluation of lymphadenopathy, thyroid nodules, soft tissue tumors
- Infectious vs. neoplastic differentiation
- Avoidance of surgical biopsy when possible
Indications
- For cytological and bacteriological examination of a mass or a lymph node.
- It aids in tissue diagnosis and in determining what the course of management should be.
Equipment Needed
A sterile tray containing:
- 2.4- to 4-cm (20- to 25-ga) needle (a small-bore needle causes less shearing force on tissues but obtains a very prompt sample)
- 10- to 20-mL plastic disposable syringe
- Clean glass slides
- 70-90% ethanol for routine wet fixation
- Containers with specific culture media (if necessary)
- Antiseptic cotton wipes in a bowl
- Pair of gloves
- Kidney tray
Preparation
- Explain the procedure to the child and parents.
- Demonstrate on stuffed toys if age appropriate.
- Use distraction techniques.
Procedure
- Perform hand hygiene and don gloves.
- Sterilize the site with antiseptic wipes.
- Local anesthesia, though usually not required, may be employed in anxious children.
- immobilize the lump or the skin over the area to be biopsied between your thumb and finger with one hand.
- Hold the syringe in the other hand and insert the needle into assigned area, perpendicular to skin surface and position the needle within target tissues.
- Pull the syringe plunger to apply negative pressure.
- As pressure is maintained, make several punctures through the lump.
- Release the negative pressure.
- While the needle remains in target tissue, withdraw the needle.
- Detach the needle, clear some air, 2-3 mL. into the syringe.
- Reattach the needle and blow aspirate on to the slide.
Post procedure Care
- Apply a plaster over the site.
- Send the specimen for laboratory test.
- Document the procedure with date and time.
Precautions to be Taken
The following factors may contribute to an unsatisfactory yield during fine needle aspiration cytology (FNAC):
- When the needle misses the lesion tangentially
- When the central area is cystic/necrotic/ hemorrhagic and devoid of diagnostic material
- When there is a small malignant lesion close to a dominant benign mass
- When the target tissue is fibrosclerotic and poor in cells
General Instructions
- As the sample tissue is very small, it gets stuck into the syringe lumen and is hard to remove. So, there is need to repeat the procedure.
- Deep biopsies can be obtained with the assistance of radiological and imaging techniques, such as ultrasonography.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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