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FNAC Test

FNAC Test - Indications, Procedure & Cost

At PACE Hospitals, we offer comprehensive FNAC testing services using state-of-the-art facility, equipment and a team of experienced doctors, radiologists and pathologists. They are having expertise in carefully evaluating condition and recommend the most appropriate FNAC procedure.

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What is FNAC test?

FNAC test full form in medical - Fine needle aspiration cytology


Fine needle aspiration cytology (FNAC) is a less invasive procedure (type of medical biopsy) performed by a pathologist or a radiologist that includes collection of cell samples from growths or masses from different parts of the body by using a thin needle. This procedure is indicated for cytopathological diagnosis or treatment of various conditions and cancer.


The FNAC test uses include the identification of the superficial lumps or masses and also to confirm the cancerous nature (FNAC test for cancer) of lump. FNAC procedure is an alternative to other more invasive methods (larger surgical procedures), such as excisional or incisional biopsy.

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Indications of FNAC test

Fine needle aspiration cytology technique, also called as FNAC biopsy, a less invasive procedure performed to obtain a cell sample from a lesion using a thin bore needle to confirm a diagnosis or to choose the treatment. 

Initially, it was developed to confirm the suspicion of reoccurrence or spreading of cancer. However, currently it is most commonly used to investigate the newly identified cysts (fluid-filled lumps) and masses in the thyroid, breast, lymph nodes, and unusual skin masses.


The following are the fine needle aspiration cytology indications:

  • To confirm the local metastasis of a known malignancy
  • To diagnose the inflammatory, neoplastic condition
  • To diagnose palpable or non-palpable lesions
  • Palpable lesion: Breast, lymph node, thyroid, soft tissue
  • Non-palpable: Abdominal cavity, thoracic cavity
  • First-line investigation for many superficial palpable swellings and deep-seated lesions such as in the mediastinum, lungs and abdominal organs, including pancreas and lymph nodes
  • To check for specific genetic or molecular cancer markers to choose the proper treatment
  • To remove the pus from an abscess as a part of its treatment (for preventing a bigger incision and drainage)
  • To drain fluid from a seroma if required. However, it may not recommend due to chance of infection

Contraindications of FNAC test

FNAC test is not recommended when the treatment will not change anything. For instance, a large, isolated and symptomatic pancreatic mass is needed to be removed surgically as a part of its treatment; however, in such scenarios, biopsy might not be preferable, as FNAC consists of the risk of spreading the cancer cells along the needle path. In addition to this, the following are the health conditions where the fine needle aspiration procedure is not recommended.

  • Pulmonary hypertension
  • Pancreatitis
  • Bleeding disorders - Thrombocytopenia, haemophilia
  • Bacteraemia/septicaemia
  • PTI - prothrombin index is less than 80%, obstructive jaundice (for Liver FNAC)
  • Elder patients with emphysema and pulmonary hypertension (for Lung FNAC)
  • Acute prostatitis (for prostate transrectal aspiration)
  • Epididymo-orchitis (for Testis FNAC) 
  • Inadvisable in suspected pheochromocytoma (Adrenal FNAC)
  • Extreme fluctuations in blood pressure (BP)


Furthermore, FNAC procedure can be avoided if patient is on the following scenarios: 

  • If there is a risk of damaging essential tissues during needle insertion into the target region
  • When the targeted region is already infected (inserting the FNAC needle spreads the infection to other tissues)
  • When cell analysis is not enough for accurate diagnosis
  • Presence of paraganglioma, vascular neoplasms and hydatid cysts

Advantage of FNAC test

Fine needle aspiration cytology (FNAC) procedure is a simple, cost-effective and easily performed outpatient procedure which can provide a confirmative and rapid diagnosis. It is a safe procedure which is a first choice for many pathologist or radiologists. It has the following advantages:

  • No required hospitalisation
  • Accurate results
  • Consumes less time and results will obtain within 1–2 days
  • No need for general anaesthesia
  • Simple office technique
  • Multiple attempts are possible in one sitting
  • Cysts can be aspirated easily
  • Lower risk than surgical biopsy
  • Useful for multifocal lesions
  • Sensitive to diagnose malignant cells
  • Minimal pain or discomfort for patient
  • Techniques such as bacterial culture, immunocytochemistry, flow cytometry, cytogenetics, polymerase chain reaction, etc, are possible from FNAC material

Disadvantages of FNAC test

Fine needle aspiration cytology (FNAC) procedure has the following disadvantages:

  • Required skills and expertise candidate
  • Septicaemia (blood poisoning due to bacteria)
  • Haemorrhage (internal bleeding)
  • May cause local tissue change
  • One small sample may not give the correct analysis (most common disadvantage of FNAC procedure)
  • False negative (Incorrect result as it indicates the absence of abnormal cells in the sample when they actually present, this happens due to technical issues, sampling error or misdiagnosis) 
  • Difficult to insert the needle on exact location
  • FNAC have to repeat, if doubtful with respect to a clinical condition

Considerations of the pathologist or a radiologist before planning FNAC procedure

  • Identifying a new mass or growth on the person's body, whether through self-checks, a pathologist or radiologist examination, or found by chance during other diagnostic tests, can be very scary for an individual. It often causes great concern and anxiety due to the unknown nature of the mass or growth. It is essential for the healthcare team to quickly provide a correct diagnosis for the patient while keeping comfort and causing less pain.
  • Even though pathologist or radiologists can now identify most new masses using advanced imaging techniques. However, in some cases, the healthcare team is completely not sure about the exact (underlying) cause for developing new masses or growths in the patient. In these cases, a fluid or tissue sample is usually required to confirm the diagnosis.
  • Finally, in some cases, fine-needle aspiration procedure may be used not only to diagnose but also to remove or drain the fluid from abscesses, cysts or seromas as a form of treatment.
  • To decide whether to perform an FNA, the pathologist or radiologist must consider whether the results of the test will help in making appropriate treatment decisions for the patient. If the test results do not impact the treatment plan, a pathologist or radiologist might not consider performing the FNAC.
  • Before performing the FNAC procedure, the whole healthcare team (doctors, nurses, and other practitioners) involved in patient care will agree that an FNA is the right diagnostic tool to determine the appropriate treatment for the patient.
  • The healthcare team collectively decide that FNA is enough to provide sufficient tissue sample without opting to more invasive procedures such as core-needle or excisional biopsy.

Before the FNAC procedure 

  • Before performing the FNAC test procedure, the pathologist or radiologists will assess the patient's overall health condition, medical history, allergies, and any bleeding disorders to check that might affect the FNAC or the patient's safety.
  • The patient will be advised to stop taking drugs such as blood thinners or anticoagulants or any other drugs that affect the blood coagulation process, several days before the day of the test. 
  • The patient will be advised to not to consume (drink or eat) anything several hours before the procedure. 
  • The pathologist or radiologists will explain the entire procedure, its purpose and the risks of the FNAC procedure to the patient. Depending on the location (site of aspiration), the pathologist or radiologist may clean and disinfect the area to prepare it for the procedure and give anaesthesia if needed.
  • In a superficial (palpable) lesion biopsy, a single pathologist or radiologist may perform the FNAC without the help of another health care team. However, if needed, having an aid available provides a smooth procedure and extra support.

FNAC procedure steps

The radiologist can feel (palpable) the lesion and evaluate its mobility, consistency and relationship to other anatomical structures.

  • The FNAC test is usually short and takes less than 10 to 15 minutes to complete. The pathologist or radiologist will use the clean and dry glass slides on the table to fill the isopropyl alcohol in coplin jars to start the FNAC procedure.
  • A patient will be comfortably positioned to expose the targeted aspiration site, and the aspiration site will be cleaned with spirit.
  • A pathologist or radiologist takes a needle syringe with a holder and attaches a disposable syringe with a gauge needle. 
  • During the procedure, ultrasound (imaging guidance) may be used to locate the area for aspiration accurately.
  • Aspiration technique: A prick will be given to the lump by inserting a needle using a vertical technique (needle is peripheral to the skin) to aspirate it by pulling the piston.
  • Aspiration will be continued on the lump by rotating the needle and moving it back and forth.
  • The pathologist or radiologist may repeat the aspiration more than once to collect tissue from various parts of the suspicious area.
  • According to the size of the lump, the needle direction will be changed, and if the lesion is too large, the aspiration may be needed in multiple sites.
  • After collecting enough samples, aspiration will be stopped, the puncture site will be covered with cotton and adhesive tape, and the patient will be asked to apply pressure for 2–3 minutes to stop.
  • Finally, the collected aspirate sample will be dropped on the surface of the slide and stained using one of the rapid stains to make a thin smear for microscopic examination.
  • In case of specimens, these are collected from enlarged thyroid lymph nodes, salivary glands, breast masses, palpable abdominal masses etc.

After FNAC procedure 

After a fine needle aspiration, the patient might recover soon and can return to normal activities, where a small bandage may be placed over the aspiration site. 


The patient will receive special care instructions after the procedure such as occurrence of pain, swelling and soreness at the puncture site. To reduce the discomfort, pathologist or radiologists may give painkillers.


In rare cases, the aspiration site may cause soreness, infection, and bleeding. In such scenarios, the patient should consult the pathologist or radiologist.

Results and interpretation of FNAC report

FNAC test typically requires two to three days to give results. The results of the fine needle aspiration cytology include the following:


  • Indicate lump to be:
  • Clearly benign: Non-cancerous
  • Clearly Malignant: Cancerous
  • Non-definitive: Unclear + requires surgical biopsy
  • FNAC test report time: FNAC report will be available within a few days to week
  • FNAC test positive result: The FNAC test positive means, the presence of abnormality in sampled cells or fluid. However, a positive result from the FNAC test does not always indicate cancer. Further tests may be required to establish a final diagnosis and stage of cancer based on the patient's medical history, symptoms, and clinical exam. Early identification and a positive FNAC result can lead to effective and timely treatment.
  • FNAC test Negative result: A negative FNAC test result includes the absence of any signs of abnormality in sampled cells or fluid. However, a negative result from the FNAC test is not always 100% accurate, and there is a slight possibility of false-negative results.


The success of FNAC test procedure depends on the following fundamental requirements 

  • Aspiration
  • Palpation
  • Smear preparation
  • Microscopy
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FNAC test for breast 

The breast FNAC test is a procedure where a thin needle will be placed through the skin to take tissue and tissue samples from solid or cystic breast lesions. FNA breast biopsies can be performed with the guidance of ultrasound when the lesion is not accessible to feel. Ultrasound imaging will not be needed for palpable breast lumps.


Diagnosis: Breast FNAC test is indicated for patients with abnormalities in mammogram or palpable breast lesions. However, the FNAC test for breast lump examination remains controversial for diagnosing cancers because it only collects a tiny sample, which is inadequate. This will make the test challenging to find if a lesion is cancerous or not.


Therapeutic: FNAC test procedure is indicated for breast cysts that are big, causing symptoms (painful), unusual growth or imaging irregularities.


It is contraindicated in patients having the following situations:

  • Skin infections 
  • On anti-coagulant therapy
  • Bleeding disorder
  • Coagulopathy
  • Deep and non-palpable lesion

FNAC test for breast fibroadenoma

A fibroadenoma is a non-cancerous (benign) tumour of the breast. Breast fibroadenomas are small in size and cannot grow big like breast cancer. This tumour cannot spread to other organs and remains in the breast tissue. It may perform to confirm the diagnosis of breast fibroadenoma in the taken sample from breast of patient. Diagnosis of fibroadenoma with FNAC offers highly accurate results.

FNAC test for thyroid

The fine needle aspiration cytology thyroid is a less invasive procedure (type of medical biopsy) performed to collect tissue or fluid samples from thyroid growths or masses by using a thin needle for diagnosis or treatment.



Thyroid nodules are common medical problem, often found during the thyroid examination and ultrasound. Most thyroid nodules are benign (non-cancerous), and they can consider as first indication of thyroid cancer. Thyroid cancer is relatively uncommon, early detection plays a major role in better survival due to its slow growth.


FNAC technique is an effective method for the initial evaluation of thyroid nodules and for diagnosing various thyroid neoplasms (tumours). The application of this method aid in decreasing the number of unnecessary thyroid surgeries. However, in low-quality samples, the FNAC technique can have challenges to identify microfollicular structures (small follicles of thyroid cells) or dense cell clusters (group of cells that are closely packed).

FNAC test for neck 

FNAC is a simple, and quick method to obtain the samples from the masses or lumps found in the neck without surgery, to determine the type of cells (benign or cancerous) present. It causes the tiniest discomfort to the patient and carries no risk of complications. It helps detect the masses within the neck and head area, including the thyroid or salivary glands.


Tuberculous lymphadenitis (lymph nodal infection by tuberculous mycobacteria) is the common cause of neck swellings, followed by non-specific lymphadenitis (swollen lymph nodes without specific cause) and metastatic cancer (cancer that can spread from its original area to a healthy area).


FNAC test is a suitable tool for assessing neck swellings in patients. Despite its limited precise diagnosis compared to tissue biopsy, it is a better test for follow-up and screening.

FNAC test for mouth 

If the oral cavity (mouth) experiences different abnormal lesions, an accurate diagnosis might be required to guide proper treatment and management.


Traditional biopsy methods are commonly used to detect mass lesions in the mouth and throat. However, using these techniques in the mouth may require anaesthesia. It can be challenging for certain oral lesions, such as trans-mucosal lesions-located within the lining of the mouth.


In today’s fast-paced society, accurate and prompt reports are crucial. FNAC is shown to be a safe, inexpensive and reliable technique that overcomes these issues by providing a less invasive and rapid diagnosis of oral lesions. If needed, oral fine needle aspiration cytology allows immediate re-aspiration (re-examination). Although FNAC is not widely used for oral and pharyngeal lesions, it has become a preferred diagnostic test for lesions in the salivary glands.

FNAC test for spleen 

The spleen is a tiny organ that stores and filters the blood and makes the WBC (white blood cells) that protect the person from infection. FNAC technique is advantageous for diagnosing cancerous and non-cancerous growths in different organs.



Especially in spleen aspiration, it is commonly used to diagnose suspected blood cancers such as lymphomas, leukaemia’s, myelofibrosis-related haematopoiesis and systemic amyloidosis.

FNAC test for lipoma

Lipomas are the common benign tumours of the soft tissue and are composed of adipose (fat) tissue. Lipoma FNAC is an easy re-aspiration method and offers a lower risk of spreading cells. It might reveal the lobulated fatty tissue with thick walls and capillaries.


The studies found that FNAC carries a 96% accuracy rate for detecting lipomatous tumours (soft tissue growth tumours). Identifying breast lipomas might be difficult due to similarities with other conditions. Other procedures may be used in diagnosing breast lipomas.

Complications of FNAC test

Although FNAC test appears to be a simple procedure, it can lead to various complications, including:

  • Local Pain
  • Infections
  • Inflammation
  • Hyperfunction
  • Pneumothorax (accumulation of air around or outside the lung)
  • Hematomas (collection of blood outside of blood vessels, due to blood vessel injury).
  • Dissemination of tumour
  • Bruising

History of fine needle aspiration cytology procedure 

In the early 1900s, Martin and Ellis were the first to use modern needle aspiration methods. A German doctor first suggested using fine needles with a small gauge. This innovation established the foundation for developing fine needle aspiration cytology (FNAC) technology.

Questions that the patients can ask the healthcare team about FNAC procedure?

  • When will I get the results of my FNAC test?
  • What do the results of my FNAC mean?
  • When can I go back to my normal activities?
  • How soon should I contact the healthcare team if I notice any unusual symptoms or issues after the procedure?
  • What signs of complications or infections should I watch out for at the aspiration site?
  • Are there any specific activities I should avoid during my recovery period?
  • Do I need any follow-up tests or appointments based on the FNAC results?

Difference between FNAC and Biopsy 

FNAC vs Biopsy 


Fine needle aspiration cytology and fine needle aspiration biopsy are effective procedures for diagnosing and treating various lumps or masses. Although these are similar, they have some differences:

Elements Fine needle aspiration cytology - FNAC Fine needle aspiration biopsy -FNAB
Preparation of Sample Collects a tiny number of cells onto a slide Thoracocentesis, pleural tap, needle thoracostomy, needle decompression
Pathological examination Microscopic examination of cells (cytology) Microscopic examination of tissue sections (Histopathology)
Purpose It is often used to look for the superficial lumps or masses and also to check the lump is cancerous in nature It may find the type of cancer and confirms the other details for future cancer treatment
Advantages Less invasive, cost effective, safe and more rapid results More precise and provides more information about tumour
Disadvantages Less accurate (it doesn’t give more information about tumour). More invasive than FNAC, slower results and expensive
Diagnosis capability Limited for specific diagnoses This provides a more conclusive diagnosis.

Frequently asked questions on FNAC test

Is FNAC test painful? 

Yes, the FNAC test procedure is generally associated with minimal discomfort and pain. In this procedure, a thin needle will be inserted into the skin to take tissue samples from cysts or masses. The level of pain or discomfort varies based on the patient's procedure location and pain tolerance.



Local anaesthesia may be used to reduce any pain during the process. So, it is typically a well-tolerated procedure and considered a low-pain approach.

What happens if FNAC test is positive?

A positive FNAC test result indicates an abnormality in sampled cells; however, a positive result does not always indicate the presence of cancer. Additional diagnostic tests may be required to diagnose the cancer stage and type based on the patient's medical history, symptoms, and clinical exam. Early identification and a positive FNAC result can lead to timely and effective treatment.

What happens if FNAC test is negative? 

A negative FNAC test result indicates the absence of abnormal cells or fluid. However, a false-negative results are possible with the FNAC test. If patient is under suspicion of a negative FNAC report, further additional tests may be needed to establish a final diagnosis based on the patient's medical history, symptoms, and clinical exam.

Can FNAC detect cancer? 

Yes, FNAC test can detect cancer. It is a less invasive procedure performed to collect tissue or fluid samples from growths or masses from different parts of the body by using a thin needle for diagnosis or treatment. It is often used to look for the superficial lumps or masses and also to check if the lump is cancerous in nature.


FNAC procedure is an essential tool for diagnosing the different types of cancers such as thyroid cancer, breast cancer and lymphomas.

How FNAC test is done? 

The pathologist or radiologist can feel (palpable) the growth and evaluate its mobility, consistency and relationship to other anatomical structures before performing the FNAC. The pathologist or radiologist disinfects the affected site and inserts a needle into the abnormal mass by vertical technique. Aspiration will be performed to collect samples by pulling the piston and rotating the needle continuously in a back-and-forth direction. Collected aspirate will be placed on the surface of the clean slide for laboratory examination to diagnose any condition.

How much does FNAC test cost in Hyderabad, Telangana?

FNAC test cost in Hyderabad ranges varies from ₹ 1,200 to ₹ 2,000 (INR one thousand two hundred to two thousand). The FNAC test is a relatively inexpensive and accurate way to diagnose lumps and nodules. However, price of FNAC procedure in Hyderabad depends upon the multiple factors such as patient age, condition, location, and insurance or corporate approvals for cashless facility.

What is the FNAC test cost in India?

FNAC test cost in India ranges vary from ₹ 800 to ₹ 2,600 (INR eight hundred to two thousand six hundred). However, price of FNAC test in India can vary depending on the patient's condition and different private hospitals, laboratories in different cities.

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