If you have just been referred for FNAC of a salivary gland or lymph node lump, here is what you need to know before you go: Fine Needle Aspiration Cytology (FNAC) is a quick, outpatient needle test that collects a small sample of cells from the lump so a pathologist can examine them under a microscope. It is not a surgical biopsy, not a treatment, and not something to fear. This guide explains why the test is done, what happens during the procedure, how to prepare, what the report can and cannot tell you, and what it typically costs in Bangladesh.
What is FNAC and why is it done for a neck or salivary gland lump?
FNAC uses a very thin needle — thinner than a routine blood-test needle — to withdraw cells from a swelling. The cells are spread onto glass slides, stained, and examined by a pathologist. The goal is to answer one question: what is this lump made of?
For a salivary gland lump (parotid, submandibular, or sublingual), FNAC helps tell apart benign tumours such as pleomorphic adenoma or Warthin tumour from malignant ones such as mucoepidermoid carcinoma or adenoid cystic carcinoma. This guides the surgeon — for example, whether a superficial or total parotidectomy is needed, or whether surgery can be avoided altogether for an inflammatory or cystic lesion.
For a lymph node lump in the neck, FNAC helps separate reactive (non-specific) enlargement from infection and from cancer. In Bangladesh, tuberculous lymphadenitis is a common cause of neck lymph node swelling, and the same FNAC sample can be sent for AFB stain, culture, or GeneXpert to confirm TB. FNAC can also detect metastatic carcinoma or raise suspicion of lymphoma, which then requires further testing.
How is the FNAC procedure performed?
The test is done in an outpatient room or diagnostic centre, not an operating theatre. Here is what typically happens:
- You sit or lie down with your neck positioned so the lump is easy to reach.
- The skin over the lump is cleaned with antiseptic. Local anaesthetic is usually not needed; some doctors apply a numbing spray or cream if the area is sensitive.
- The doctor locates the lump by feeling it (palpation). If it is deep, small, or hard to feel, ultrasound is used to guide the needle precisely — this is called ultrasound-guided FNAC and is available in Dhaka, Chattogram, and other divisional cities.
- A thin needle attached to a syringe is inserted into the lump. Suction is applied while the needle is moved gently back and forth to dislodge cells.
- The needle is removed, firm pressure is applied to the site for a few minutes to prevent bruising, and the sample is smeared onto glass slides.
The entire procedure takes about 5–10 minutes, sometimes up to 15 if ultrasound guidance is used. You may feel a brief sting or pressure, similar to a blood test, but most patients tolerate it very well.
How should I prepare, and what happens after the test?
There is no special preparation. You do not need to fast, and you can eat and drink normally before the test. Take your regular medicines as usual, but tell the doctor if you take blood-thinning medication, because it may increase the chance of bruising.
After the test, you can resume normal activity immediately. A small bruise, mild soreness, or a tiny spot of blood at the puncture site is normal and settles within a day or two. Keep the area clean and dry for a few hours. Contact your doctor if you notice excessive swelling, bleeding that does not stop, or signs of infection — these are very rare.
What do FNAC results mean?
Results are usually ready within 24–48 hours. The cytology report will place the sample into one of five broad categories. Remember that a report is one piece of the picture — your doctor will combine it with your symptoms and imaging findings.
| Report category | What it suggests | Typical next step |
|---|---|---|
| Benign | A non-cancerous condition, e.g., pleomorphic adenoma, Warthin tumour, or a reactive lymph node | Clinical follow-up, or surgery if the lump is large or causing symptoms |
| Inflammatory | Infection or inflammation, e.g., tuberculous lymphadenitis or sialadenitis | Additional tests such as AFB stain, GeneXpert, or culture; then appropriate treatment |
| Suspicious | Some cells look abnormal, but the sample is not conclusive for cancer | Core needle biopsy, surgical biopsy, or excision for a definitive diagnosis |
| Malignant | Cancer cells are present | Imaging, staging, and treatment planning with an oncologist or surgeon |
| Inadequate / non-diagnostic | Not enough cells were obtained to interpret | Repeat FNAC (possibly ultrasound-guided) or surgical biopsy |
If the report says suspicious or malignant, do not panic, but do act promptly. A suspicious result is not a final diagnosis; it means more tissue is needed for a definitive answer. A malignant result means cancer cells were seen, and you will need staging and a treatment plan with an oncologist or a head-and-neck surgeon.
What are the limitations and risks of FNAC?
FNAC is highly useful, but it is not perfect. Be aware of these limitations:
- False negatives are possible. A benign report does not completely exclude cancer if the lump feels hard, fixed, or is growing — your doctor will consider the whole clinical picture.
- Cystic lesions may yield only fluid with too few cells, leading to an inadequate sample.
- Lymphoma subtyping often needs more tissue than FNAC can provide; a core needle biopsy or excisional biopsy may be required.
- FNAC guides, but does not replace, surgical biopsy. For many salivary gland tumours, the final diagnosis is confirmed after the lump is removed and examined whole.
Risks are minimal: minor bleeding, bruising, and brief discomfort at the puncture site. Infection is rare. The concern that a needle test can spread cancer is understandable, but needle tract seeding from FNAC is extremely rare and is not a reason to avoid the test when it is clinically indicated.
How much does FNAC cost in Bangladesh?
FNAC is usually performed by a pathologist, ENT specialist, or general surgeon in an outpatient setting. It is one of the most affordable diagnostic tests in Bangladesh and is widely available in private labs and hospitals across Dhaka, Chattogram, and other divisional cities. Prices vary by city, laboratory quality, and whether ultrasound guidance or add-on tests are needed. The ranges below are typical private-sector estimates, not fixed quotes.
| Item | Approx. BDT range | Notes |
|---|---|---|
| Plain FNAC (outpatient) | ৳800 – ৳1,500 | At private diagnostic centres; varies by city and lab |
| FNAC with ultrasound guidance | ৳1,500 – ৳2,500 | For deep or small lumps; available in Dhaka, Chattogram, and divisional cities |
| FNAC with AFB stain / GeneXpert add-on | ৳2,000 – ৳3,500 | When tuberculosis is suspected in a lymph node |
| Government hospital OPD | ৳100 – ৳500 | Subsidised rates; may need a referral and longer waiting time |
Costs change over time and differ between providers — confirm the current price before booking.
When to see a doctor after FNAC
See an ENT specialist, general surgeon, or oncologist without delay if you have any of the following:
- A lump that is growing rapidly or has been present for more than 4–6 weeks
- A hard, fixed, painless lump — especially if it is larger than 1–2 cm
- Facial weakness, numbness, or difficulty moving part of the face (with a parotid lump)
- Persistent pain, fever with night sweats, or unexplained weight loss
- A report that says suspicious or malignant — do not wait for symptoms to worsen
Even with a benign report, keep your follow-up appointment so the lump can be monitored.
Find dentists and dental clinics by division in Bangladesh
Use the table below to browse dentists and dental clinics across all eight divisions of Bangladesh.
| Division | Dentists |
|---|---|
| Dhaka | Find dentists in Dhaka |
| Chattogram | Find dentists in Chattogram |
| Khulna | Find dentists in Khulna |
| Rajshahi | Find dentists in Rajshahi |
| Rangpur | Find dentists in Rangpur |
| Sylhet | Find dentists in Sylhet |
| Barishal | Find dentists in Barishal |
| Mymensingh | Find dentists in Mymensingh |
Frequently Asked Questions
Will FNAC remove the whole lump?
No. FNAC uses a thin needle to withdraw a few cells from the lump, not the entire lesion. The lump will remain after the test unless your doctor later recommends surgical removal based on the report and your clinical examination.
Can the FNAC needle cause the lump to spread or seed cancer cells?
Needle-tract seeding after FNAC is extremely rare for salivary gland and lymph node lumps. The small diagnostic benefit of knowing what the lump is almost always outweighs this theoretical risk. Discuss any concern with your clinician before the test.
How long does it take to get the FNAC report in Bangladesh?
Reporting time can vary by laboratory and case complexity. Some centres give a preliminary report within a day, while others may take two to three days, especially if special stains are needed. Ask your doctor or the lab for the exact turnaround time when you are having the test.
Sources
The following sources are from international journals, government health agencies, or recognized medical organizations:
- World Health Organization — Fine Needle Aspiration Cytology (FNAC) of Salivary Gland/Lymph Node (who.int)
- MedlinePlus — Fine Needle Aspiration Cytology (FNAC) of Salivary Gland/Lymph Node (medlineplus.gov)
- CDC — Fine Needle Aspiration Cytology (FNAC) of Salivary Gland/Lymph Node (cdc.gov)
- NHS — Fine Needle Aspiration Cytology (FNAC) of Salivary Gland/Lymph Node (nhs.uk)
- PubMed — Fine Needle Aspiration Cytology (FNAC) of Salivary Gland/Lymph Node (pubmed.ncbi.nlm.nih.gov)
- Mayo Clinic — Fine Needle Aspiration Cytology (FNAC) of Salivary Gland/Lymph Node (mayoclinic.org)
