Prior to FNAC or core biopsy, it is very important to know the patient’s medical history and if there are any contraindication factors to the patient having a FNAC, e.g., bleeding disorder, anticoagulation medication, e.g., warfarin, heparin, rivaroxaban, etc., steroid medication and any drug allergies.

Patient’s consent: In the UK, it is vital to have a patient’s consent for any intervention procedure. Depending on your local hospital policy, this may be verbal or written consent. Patient should be informed of the expected risks and complications that may arise from the procedure. This includes pain, swelling, bruising, bleeding, possible damage to the nerve giving rise to nerve palsy, infection, abscess/tumor tracking through the needle track, scar formation and non diagnostic sampling. In any patient who has a history of keloid scar formation or whom form scar easily, a skin incision should be avoided where possible eg during the insertion of a core biopsy needle.

Prior to inserting the needle, it is very important to wipe the skin of any US gel contamination. As this can cause artifacts on the slide. It is also important to disinfect the skin with an antiseptic solution. During the FNAC, instead of the US gel, chlorhexidine solution can be used as a lubricant (Figs. 20.3 and 20.4). Skin that has not been cleaned or usage of non sterile needle may cause abscess formation.

There are two techniques for US-guided FNAC: (1) Using parallel technique or (2) perpendicular technique (Figs. 20.5, 20.6, and 20.7).

These images have been taken from [1].