Exfoliative cytology

exfoliative cytology

1. Exfoliative Cytology By Shamin Joshi

2. Exfoliative cytology Microscopic examination of shed cells from body surfaces or cell harvested by rubbing or brushing a lesional tissue surface . First introduced by Papanicolau in 1941 . It’s a simple , pain free ,non invasive and rapid technique . This technique is only used for study of superficial cells and requires other cytological analysis to confirm .

3. Indication multiple or large red lesions Lesion located in region that presents surgical difficulty Patient with anticoagulant drug n bleeding disorder Older people who can not tolerate surgical procedure When herpes or candida suspected Follow up for detection of recurrent cancer

4. Sites of smear Buccal mucosa Junction between hard and soft palate Dorsum of tongue Floor of mouth

5. Classification of smear Class I – normal, normal cells are observed Class II – atypical , indicates presence of minor atypia but no evidence of malignant changes Class III – indeterminate in between cytology that separates cancer from non cancer diagnosis , atypia may suggest cancer ,but not clearly may represent pre cancerous lesion or Carcinoma in situ , biopsy recommended

6. Class IV- suggestive of cancer , few cells with malignant character or many cells with border line characters , biopsy mandatory Class V – positive for cancer , cells those are obviously malignant , biopsy is mandatory ( EC has some limitations presence or extent not assessed )

7. Technique Lesion is stroked vigorously in one direction with wet wooden tongue blade or cotton tip applicator or cyto brush Cells spread / smeared is collected on glass slide Then its immediately fixed with commercially available spray ( ethanol ,alcohol ether ) After drying , slide is packed and sent to oral pathology lab Then its stained by papanicolous stain and studied under microscope .

8. Procedure

9. Uses Early detection and control of herpes simplex infection , candidiasis , pemphigus vulgaris , benign intraepithelial dyskeratosis , keratosis follicularis , sickle cell anemia Assessment of nutritional iron deficency Forensic dentistry ( cells from tooth brush, gender) Prediction of cellular response of tumour to irradiation

10. Contraindication An obvious cancer that would justify a biopsy Sub mucosal lesions White lesion that do not rub off

11. Disadvantage Non invasive and painless Early diagnosis of lesions Minimal skills and instruments required Can be used in patients with systemic disorders where biopsy is contraindicated Patients complains Cost effective False negative results(malignancy go undetected) False positive results (definitive t /t not indicated until biopsy is done) No depth or extent known Contaminations Low sensitivity Advantage

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