Exfoliative cytology

cytology

1. Exfoliative cytology Dr Sandeep singh NSCG

2. Introduction A branch of cytology which deal with the microscopic study of cells that have been desquamated from the epithelial surface. Indication- Detection of malignant cells or precancerous lesion. Detection of asymptomatic or pre cancerous cervical lesion in women. Assessment of female hormonal status in case of sterility. Detection of infectious microorganism.

3. Cytology Specimen Cervicovaginal smear Peritoneal, pericardial or pleural fluids CSF Nipple discharge Bronchial brushing Sputum Gastirc lavage Urine sediment Prostatic secretion

4. Body fluids Collection procedure- a minimum pf 10 ml specimen is desirable for optimal cytological evaluation. Heparin may be added to reduce clotting. Always submit the specimen with the requisition form. the specimen should be refrigerated until transportation to the lab.

5. Nipple Discharge Gently strip the sub areolar area and nipple with thumb and fore finger. Place the slide upon the nipple and draw it quickly across the nipple. When drop or fluid is obtained spread it with another slide. Immediately put the slide in fixative.

6. Bronchial brushing Bronchoscopically directed brushing of identical cases. Using standard technique, identify the lesion and obtain a brushing sample of the lesion. Gently apply the sample on the glass slide and immersed in the fixative.

7. Gastric Washing Endoscopically obtain washing of the region of the suspected lesion. Patient should fast overnight or for minimum 6 hrs prior to procedure. Lavage the area of interest with physiological solution. Aspirate the solution in clean container. If transport of specimen delayed more than 4 hrs , specimen should be refrigerated.

8. Cancer Cervix Most cases are diagnosed at very late stages. At this stage treatment is expensive. Most cases are untreated at late stage and cure is impossible. Cervical cancer is preventable type of cancer. Change in cervix occur for about 8-10 years before cancer develop. These change can be detected easily.

9. Cervicovaginal smear Ayre’s spatula

10. Ayre spatula (plastic)

11. Fixation Fixative is an agent used to prepare cytological specimen for the purpose of preserving and maintaining the existing form and structure of all elements. Fixative – 95% ethanol 100%methanol 95% rectified spirit 80% isopropanol Spray fixative contain isopropanol and propylene glycol.

12. Pap stain Objective - the purpose of staining is to stain nuclear chromatin, staining of the cytoplasm of different cell types into different colour and intensity and to retain cytoplasmic transparency. Chemical agents - Harris hematoxylin, OG- Modified ( orange G colour , phosphotungustic acid, ethanol and glacial acetic acid)

13. Procedure