FNAC Test in Pokhara — Ultrasound-Guided Fine Needle Aspiration

What is FNAC?

An FNAC test in Pokhara at Kaligandaki Diagnostic and Research Center (KDRC) is fine needle aspiration cytology: a very thin needle is passed into a lump or swelling to draw out a small number of cells, which are spread on glass slides and examined under a microscope by a pathologist. It is one of the quickest and least invasive ways to find out what a lump is made of.

"Fine needle aspiration" describes the method, and "cytology" means the study of cells. RadiologyInfo describes FNA as a very small needle attached to a syringe that withdraws fluid or clusters of cells. Because the needle is so thin, MedlinePlus notes that numbing medicine is often optional. There is no cut and no stitches, and most people return to normal activity straight away.

FNAC is most often used for swellings in the neck, especially thyroid nodules and enlarged lymph nodes, and for breast, salivary gland and other lumps just under the skin. At KDRC it can be done by feeling the lump (palpation) or, for small and deep lumps, under live guidance from our HD ultrasound.

Which lumps can be tested with FNAC?

FNAC can test almost any lump that can be felt or seen on ultrasound and reached safely with a fine needle. Your doctor or radiologist decides whether FNAC is the right first test for your lump. The table below shows common sites and what the test can help clarify.

Breast lumps: FNAC or core biopsy?

For breast lumps, FNAC is useful for draining cysts and sampling simple-looking lumps, but many breast specialists prefer a core needle biopsy for solid lumps because it gives the pathologist more tissue. RadiologyInfo notes that a breast core biopsy usually takes three to six samples. Your doctor and radiologist will advise which test suits your lump.

FNAC answers the question "what kind of cells are in this lump?" It does not replace imaging. Most patients first have an ultrasound scan, which shows the size, position and appearance of the lump and the safest needle path.

Palpation-guided vs ultrasound-guided FNAC

Ultrasound-guided FNAC is preferred when a lump is small, deep, partly cystic or close to blood vessels, because the radiologist can watch the needle tip enter the exact target on screen. Palpation-guided FNAC, done by feeling the lump with the fingers, suits larger lumps just under the skin. The American Thyroid Association notes that when ultrasound guides a thyroid biopsy, a non-diagnostic sample occurs in fewer than 5% of cases.

At KDRC, ultrasound-guided FNAC is performed by our consultant radiologists, who scan the swelling first and then sample it in the same sitting. This avoids a separate trip for the scan and lets the radiologist choose the most informative part of the lump, for example the solid portion of a mixed nodule rather than the fluid.

FNAC vs core needle biopsy: what is the difference?

FNAC collects loose cells through a very thin needle, while a core needle biopsy uses a slightly larger, spring-loaded needle to remove thin cylinders of tissue that keep their structure. RadiologyInfo explains that a core needle collects one tissue "core" per insertion and is usually repeated three to six times for a breast lump. Both samples go to a pathology laboratory, but they answer slightly different questions.

Neither test is "better" in every case. FNAC is quicker and gentler, and is often enough to answer the question. If the cells are inconclusive, or the diagnosis depends on tissue architecture, as in some lymphomas, your doctor may recommend a core biopsy, which is also available at KDRC.

How to prepare for an FNAC test

FNAC needs very little preparation: you can usually eat, drink and take your normal medicines. The American Thyroid Association notes that fasting is not required for thyroid FNA. The most important step is to tell us about blood thinners, because MedlinePlus advises that medicines such as aspirin, clopidogrel or warfarin may need to be paused for a few days. Never stop a prescribed medicine without asking the doctor who prescribed it.

Wear a top that makes the area easy to reach, such as an open-necked shirt for a neck lump. Bring your referral slip and any earlier ultrasound or FNAC reports, because comparing them helps the radiologist target the right lump.

What happens during an FNAC test at KDRC?

An FNAC test at KDRC is a short outpatient procedure in which the needle itself is in the lump for only seconds at a time. The whole visit is mostly registration, positioning and a short rest afterwards.

1. Check-in. Staff confirm your details, referral, allergies and any blood-thinning medicines.
2. Scan and plan. For guided FNAC, the radiologist scans the lump with ultrasound to choose the best target and path.
3. Clean the skin. The skin is cleaned with antiseptic. Local anaesthetic may be used, though it is often unnecessary with such a fine needle.
4. Take the sample. The needle is moved gently within the lump for a few seconds. The ATA notes that several samples are usually taken from different parts of a thyroid nodule.
5. Prepare the slides. The cells are spread on glass slides and labelled for the pathology laboratory.
6. Pressure and plaster. Firm pressure stops any bleeding and a small plaster is applied. You can usually leave soon after.

Is FNAC painful? Safety and side effects

FNAC is usually no more painful than a blood test. MedlinePlus describes a sting if numbing medicine is injected and a feeling of pressure as the needle enters the thyroid, but not pain. Afterwards there may be mild discomfort and slight bruising that fades quickly.

• Common: mild soreness and a small bruise at the needle site.
• Uncommon: a small collection of blood (haematoma) under the skin.
• Rare: infection, or for thyroid FNA, bleeding in or around the gland. MedlinePlus notes that severe bleeding pressing on the windpipe is rare.

RadiologyInfo reports that infections needing antibiotics after needle biopsy occur in fewer than one in 1,000 cases. FNAC uses no radiation; ultrasound guidance uses sound waves.

After a thyroid or neck FNAC, seek emergency care at once if the neck swells quickly, or if you have difficulty breathing or swallowing. Contact a doctor if the site keeps bleeding despite firm pressure, becomes increasingly painful, red or hot, or if you develop a fever.

Thyroid FNAC in Pokhara: understanding your result

Thyroid FNAC is the standard test for deciding whether a thyroid nodule needs treatment, and most results are reassuring. According to the American Thyroid Association, more than 90% of thyroid nodules are benign. Thyroid cytology reports use standard result categories, which the ATA summarises as follows.

Your endocrinologist, ENT surgeon or physician will interpret the report together with your thyroid blood tests and ultrasound findings. A non-diagnostic result is not a failure; it simply means the test needs repeating.

What happens after a benign thyroid FNAC?

A benign result usually means the nodule can be watched rather than removed. Your doctor will normally arrange follow-up ultrasound scans to check that the nodule stays stable in size and appearance. Surgery may still be discussed if a benign nodule is large enough to cause pressure symptoms, such as difficulty swallowing, or for cosmetic reasons. If a nodule grows noticeably or its appearance changes on a later scan, a repeat FNAC may be recommended.

Lymph node FNAC in Pokhara

Lymph node FNAC is commonly used to find out why a node in the neck, armpit or groin has become enlarged. Most enlarged nodes are a reaction to infection, but a node that is hard, growing or persists for weeks needs checking. MedlinePlus lists causes of abnormal lymph node results ranging from mild infections to tuberculosis, lymphoma and cancers such as breast, lung and oral cancer.

In Nepal, tuberculous lymphadenitis is an important cause of neck swelling, and FNAC is a common first test for it. The aspirated material can be examined for features of tuberculosis, and your doctor may request extra laboratory stains on the sample. If lymphoma is suspected, a core biopsy or surgical removal of a node is often needed, because the pathologist must see how the cells are arranged.

Before FNAC, an ultrasound of the neck shows the size and internal structure of the node. Some features help the radiologist choose which node to sample. Further imaging, such as a CT scan, may be added by your doctor if a wider view of the chest or abdomen is needed.

FNAC in pregnancy, children and people on blood thinners

FNAC is generally safe for most people, including in special situations, as long as the team knows about them in advance.

During pregnancy

FNAC involves no radiation, and ultrasound guidance uses sound waves, so it can usually be done during pregnancy when your doctor feels the result cannot wait. Tell us you are pregnant so we can position you comfortably and plan any local anaesthetic.

Children

Children often have enlarged neck nodes from infections, and most do not need FNAC. When a child's doctor does request it, the fine needle and short procedure make it well tolerated. A parent can stay with the child; please call ahead so we can plan the visit.

Blood thinners and bleeding disorders

Mention aspirin, clopidogrel, warfarin, newer blood thinners, herbal supplements and any bleeding tendency when booking. The doctor who prescribed your medicine decides whether it should be paused.

FNAC results: what happens to the sample?

FNAC samples are sent to a pathology laboratory, where a pathologist stains the slides and examines the cells under a microscope before issuing a cytology report. The radiologist or doctor who takes the sample does not give the final diagnosis; the pathologist does. Staining and careful reading take time, so the report usually follows within a few working days. Our team will tell you when to collect it.

Take the report to the doctor who referred you. They will explain the result, compare it with your ultrasound findings and decide on next steps, which may be reassurance, follow-up scans, a repeat FNAC, a core biopsy or a surgical opinion.

How much does an FNAC test cost in Pokhara?

The cost of an FNAC test in Pokhara depends mainly on whether ultrasound guidance is needed, how many sites are sampled and which laboratory tests the pathologist performs. KDRC quotes each case individually rather than publishing a single fixed price. Call 061-553538 or 9856077433 for the current FNAC price.

Why choose KDRC for FNAC in Pokhara?

KDRC combines HD ultrasound and experienced consultant radiologists in one place, so your lump can be scanned and sampled accurately in a single visit. Ultrasound-guided FNAC at KDRC is performed by our consultant radiologists.

• Dr. Bishworaj Bastakoti, consultant radiologist since the institute's inception, trained at the National Kidney and Transplant Institute, Manila, and a Diplomate of the Philippine College of Radiology.
• Dr. Nawaraj Paudel, consultant radiologist since inception and former assistant professor of radiology at Universal College of Medical Sciences, trained at East Avenue Medical Centre, Manila.

Both are members of the Nepal Radiologist Society and NMC-registered radiologists since 2016. Learn more about our radiologists.

• Scan and sample in one sitting. The same radiologist who scans the lump guides the needle, so the target matches the imaging.
• Clear referral pathway. Slides go to a pathology laboratory and the cytology report comes back to you for your doctor.
• Further tests under one roof. If more detail is needed, colour Doppler, core biopsy and CT are available at KDRC. See all our diagnostic services.

Booking an FNAC test and getting to KDRC

To book an FNAC at KDRC, call 061-553538 or 9856077433 (mobile/Viber), or use the appointment form. A doctor's referral is recommended so the radiologist knows which lump to sample and why. If you want to know whether we can see you on a Saturday or holiday, please call to confirm a time.

KDRC is on Shantipath at Amarsingh Chowk, Pokhara-10, Kaski. Bring your referral, earlier scan or FNAC reports and a list of medicines. No fasting is needed, and you can usually travel home normally afterwards. Referring doctors can contact our team by phone or at kaligandaki.dc@gmail.com.