exfoliative cytology and fnac.pptx

I was in BDS 3rd year when I have done that

1. GOOD MORNING. B iopsy and exfoliative cytology. Submitted By : Guided By : Gourab Kundu. DR. Kartikay Roll no – 27 Saxena. 3 rd Year BDS

2. Exfoliative Cytology: ‘Exfoliation’ means ‘ shedding ’ and ‘Cytology’ means the study of cells . Hence Exfoliative Cytology means The study of cells which exfoliate or abraded from the body surface. Application of cytodiagnosis as a routine test in the detection of cancer was introduced by George N Papanicolaou in 1941 . Normal epithelium undergoes exfoliation or shedding of its superficial cells due to physiologic turnover. The cells of the deeper layers are normally adherent to each other but if there is any pathological condition present in the epithelium the cells may loose their cohesiveness and shed along with the superficial cells. These exfoliated cells as well as cells which are scrapped of by specific instruments are studied under microscope.

3. Why do we need Exfoliative Cytology: According to Von Hamm numerous cases Of patients with oral cancer in which the diagnostic accuracy of cytologic smears was compared with that of the surgical biopsy and was found to be almost identical, he concluded that: Cytology is not a substitute but an adjunct to the surgical biopsy. It is a quick, simple, painless and bloodless procedure. It helps as a check against false-negative biopsies. It is especially helpful in follow-up detection of recurrent carcinoma in previously treated cases. It is valuable for screening lesions whose gross appearance is such that biopsy is not warranted.

4. Materials Required: Gauze Microscopic slides Cell harvesting instruments: 1. Wooden spatula or ice-cream stick. 2. Metal spatula 3. Cytobrush 4.Tooth brush Slide marking pencils Fixative Stains Microscope

5. Procedure: The preferred technique is relatively simple. At first the surface of the oral lesion containing debris and mucin is cleaned with the wet gauze. In case of tender lesions Local Anaesthetic are applied. In case of keratotic lesions curettes or small diamond stones are used to remove the keratin layer. Smear is taken from the pink tissue. Then the entire surface of the lesion is scrapped vigorously several times with the Wooden spatula or the metallic spatula or the cytobrush . The collected material is then quickly spread over the microscopic slide evenly and fixed immediately before the smear dries.

6. The fixative maybe either commercial preparation such as Spray- cyte and 95% alcohol or equal parts of alcohol and ether. After that the smear should be allowed to air-dry for 30 minutes. Then stained with Papanicolaou stain Finally mounted and studied under microscope. Two smears are always submitted from each lesion and in preparing the duplicate slide a separate scrapping should be utilised.

7. Papanicolaou Stain: Introduced by George N Papanicolaou . composition: Harris hematoxylin Orange G6 EA50 Light green SF Eosin Alcohol Glacial acetic acid Outcome: Hematoxylin - Nuclei-Blue / Black Light green SF- Cytoplasm-Blue / green OG6- keratinizing cells-pink / orange Eosin Y- Squamous cell, RBC-Red / pink

8. Systemic Study Of Smears: The cytologic smear will usually be reported by the cytologist as falling into one of five classes. These are: CLASS 1 ( Normal ): Indicates that only normal cells were observed. CLASS 2 ( Atypical ): Indicates the presence of minor atypia but no evidence of malignant changes. CLASS 3 (Indeterminate): This is an in-between cytology that separates cancer from non-cancer diagnosis. The cells display wider atypia that may be suggestive of cancer but they are not clear cut and may represent precancerous lesions or carcinoma in situ. Biopsy is recommended. CLASS 4 (Suggestive of cancer): A few cells with malignant characteristics or many cells with borderline characteristics. Biopsy is mandatory. CLASS 5 (Positive for cancer): Indicates cells that are obviously malignant. Biopsy is mandatory.

9. *Normal cells *HPV altered cells

10. LIMITATIONS: Though Exfoliative Cytology study has a significant role in cancer diagnosis,it has its own limitations: 1. The extent of invasion can’t be assessed. 2. Majority of benign lesions that occurr in the oral cavity do not lend themselves to cytologic smear. 3. Leukoplakia doesn’t lend itself to cytologic diagnosis because of the scarcity of viable surface cells in the smears taken from such lesions. 4. Finally it should be remembered that a negative cytology report does not rule out cancer and that a repeat smear or biopsy is indicated in all clinically suspicious lesions.

11. ADVANTAGES: It has been recognised that the exfoliative oral cytologic smear is also of value in the diagnosis of disease other than carcinoma, disease s which are characterized by the presence of certain specific cells. Cytologic smears have been useful in the diagnosis of lesions of Herpes simplex virus Pemphigus vulgaris Keratosis follicular is
White sponge nevus Estimation of the antioxidant level using the oral exfoliated cells. Cells retrieved from household objects such as a toothbrush for identification of a person or determination of gender find useful application in forensic odontology.

12. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC): It is the cytological study of tumour cells to find out the disease and also to confirm whether it is malignant or not by using a thin bore needle. This technique is based on the fact that tumour cells are less cohesive than the normal cells. This technique was introduced by Martin and Ellis in 1934 using 18G needle. In 1982 A John Webb detailed standard FNAC using 21 G needle.

13. Indications: It is used in the diagnosis of Breast lump Thyriod nodules Liver disease Subcutanious soft tissue mass Salivary gland disease Oral disease. Contraindications: It is absolutely contraindicated in testicular tumour because tough tunica albugenia usually prevents tumor spread and once it get disrupted by FNAC spread can occur.

14. Equipments : Needles: usually 22-23 gauge needle is used Syringes: 20 ml syringe Pistol handle Sterile container Slides: Clean,dry and grease free A 0.4 cm heamocytometer coverslip Fixatives: 70%-90% ethanol,10% buffered formalin Stains Microscope

15. Procedure: The PRINCIPAL : The negative pressure created within the syringe by aspiration holds the tissue against the sharp cutting edge of the needle,so that the tissue will be cut by the cutting end of the needle and accumulates within the lumen of the needle/syringe tip. The site of FNAC should be cleaned by spirit swab The needle is introduced into the swelling and is gently moving to and fro . Simultaneously negative suction is also created by withdrawing the piston. Then the needle is removed from the site. Now air is taken into the syringe and the needle is reattached. The aspirated material is expelled and the smear is made by gently pressing the upper slide on the lower one.

16. Sample is expelled on to a clean and dry microscope slide using air in a syringe. Then the smear is air dried and fixatives are added. The smear is stained with PAP stai /Romanowsky stain. Finally the slide is mounted and observed under microscope.

17. Advantages: Very sensitive Least invasive, safer Anasthesia not required. Disadvantages: Negative results doesn’t rule out malignancy. Thank You.