EXFOLIATIVE CYTOLOGY

INTRODUCTION:
>EXFOLIATIVE –DEAD TISSUE FALLING OFF IN
THE FORM OF LAYER.
>IT IS THE STUDY OF CELL WHICH ABRADE OR
EXFOLIATE FORM THE BODY SURFACE.
>THIS TECHNOLOGY IS INTRODUCED BY
DR.GOERGE PAPANICOLAV WHO IS ALSO
KNOWN AS FATHER OF CYTOLOGY AND THE
TECHNIQUE IS CALLED AS PAP SMEAR.
 PRINCIPLE PAP SMEAR:
>NORMAL CELL -INDIVIDUAL CELLS CAN
OFTEN BE DIAGNOSED AS SUCH
MICROSCOPICALLY BY THEIR LARGE SIZE,THEIR
PLEOMORPHIM,INCREASED NUCLEO-
CYTOPLASMIC RATIO,HYPERCHROMATISM AND
PROMINENCE OF NUCLEI AND THEIR
ABNORMAL MITOSIS.
>DYSPLASTIC CELLS -CANCER CELLS
EXFOLIATE MORE EASILY THAN NORMAL CELLS
MOST LIKELY DUE TO THEIR LOWERED
COHESIVENESS AS A RESULT OF EITHER
DECRAESE IN NUMBER OF TIGHT JUNCTION OR
LOWER CALCIUM CONTENT.
 ADVANTAGES:
>TIME SAVING: CYTOLOGY IS QUICK
PROCEDURE SO IT SAVES A LOT OF TIME.IT IS
SIMPLE PROCEDURE.
>PAINLESS: AS IT IS PAINLESS IT CAUSES
MINIMUM DISCOMFORT TO THE PATIENT.
>LOW COST : COST OF PERFORMING
CYTOLOGY IS LESS AS COMPARED TO COST OF
BIOPSY.
>NO ANAESTHETIA : IT DOES NOT REQUIRED
ANESTHESIA.
>FALSE NEGATIVE BIOPSY: IT HELP TO
CHECK AGAINST FALSE NEGATIVE BIOPSY.
>FOLLOW UP: IT IS ESPECIALLY HELPFULL IN A
FOLLOW UP DETECTION OF RECURRENT
CARCINOMA.
>SCREENING TEST: IT IS VALUABLE FOR
SCREENING LESION WHOSE GROSS
APPEARANCE IS SUCH THAT BIOPSY IS NOT
WARRENTED.

>SAFETY: IT IS A SAFE PROCEDURE AS

COMPLICATION ARE RARE.
>RAPID DIAGNOSIS : IT ENABLE A RAPID
DIAGNOISIS.
>BLOODLESS PROCEDURE : AS IT IS
BLOODLESS PROCEDURE THERE IS LESS RISK OF
DELAYED WOUND HEALING AND INFECTION.
>ACCURACY: THEY ARE REPORT OF
100%ACCURACY IN LYMPH NODE ASPIRATION
FROM METASTATIC CARCINOMA, MELANOMA,
HODGKINS AND NON-HODGKINS LYMPHOMA.
 DISADVANTAGE
FIRM-TUMORS MAY PREVENT A PROPER
CYTODIAGNOSIS DUE TO PAUCITY OF CELLS IN
THE ASPIRATE.

>FALSE NEGATIVE RESULTS:- CAN GIVE FALSE-

VE FINDINGS DUE TO INADEQUATE
SAMPLING .ANOTHER REASON FOR THIS IS
THAT MANY LESIONS HAVE A THICK
KERATINIZED SURFACE LAYER AND CONTAIN
SUBTLE CHANGE OF DYSPLASIA.
>NON-ASSESSMENT:- SOME SPECIMENS
CANNOT BE ASSESSED DUE TO POOR
CELLULITY.
 INDICATIONS
>PATIENT PREFERENCE:
AS A COMPROMIS , WHEN THE
PATIENT REFUSES FOR BIOPSY.

>FOLLOW-UP:
AS A MEANS OF FOLLOW UP FOR
RECURRENCE IN PATIENTS WHO HAD
RADIATION THERAPY FOR THE LESION THAT
WAS SUPERFICIAL OR ADJACENT TO
BONE,PERIODIC RECALL OF HIGH RISK
PATIENT.
>DEBILITATED PATIENTS:
IN PLACE OF BIOPSY , WHEN
DEALING WTH EXTREMELY DEBILITATED
PATIENTS POSSESSING PROBLEMS TO
DETERMINE A SUITABLE BIOPSY SITE.

>ADJUNCT TEST:
AS AN AID TO THE DIAGNOSIS OF
SOME DERMATOLOGICAL DISEASES SUCH AS
PEMPHIGUS ,WHITE SPONGE NEVUS,ORAL
MALIGNANT AND PRE MALIGNANT LESIONS.

>PERIODIC REVIEW:
PERIODIC REVIEW OF ORAL
CANCER LICHEN PLANUS SHOULD BE CARRIED
BY THIS METHOD.
>RAPID EVALUATION:
FOR RAPID EVOLUTION OF
AN ORAL LESION THAT ON CLINICAL
GROUNDS,IS THOUGHT TO BE MALIGNANT OR
PRE MALIGNANT AND FOR WHICH ,THE
DENTIST IS UNABLE TO OBTAIN PERMISSION
FOR A BIOPSY.

>SEQUENTIAL LABORATORY EVALUATION:

FOR SEQUENTIAL LABORATORY
EVALUATION OF AN AREA OF THE MUCOSA
THAT HAS PREVIOUSLY BEEN TREATED BY
RADIATION OR BY EXCISIONAL BIOPSIES TO
REMOVE MALINGNANCY.
>VESICULAR LESION : FOR EVALUATION OF
VASICULAR LESIONSWHERE FACILITIES FOR
RAPID EVALUATION OF TZANK SMERARS ARE
NOT AVAILABLE.

>POPULATION SCREENING:
WHEN POPULATION SCREEENING IS
DONE FOR THE DETECTION OF ORAL CANCER
EXFOLIATIVE CYTOLOGY IS RECOMMENDE
METHOD.
 INSTRUMENTS USED
INSTRUMENTS WHICH ARE USED IN
EXFOLIATIVE CYTOLOGY ARE GLASS
MICROSCOPIC SLIDE,LEAD PENCIL,CEMENT
SPATULA OR WAX CARVER, WOODEN TONGUE
DEPRESSOR,TOOTHPICK,CANISTER OF
CYTOSPRAY AND 95% OF ISOPRPYL ALCOHOL
OR ETHYL ALCOHOL.
 PROCEDURE
>INFORMATION TO BE WRITTEN ON SLIDE:
USE OF TWO SLIDESFOR EACH SITE TO
BE SAMPLED. WITH LEAD PENCIL PRINT THE
PATIENT’S NAME,DATE WHEN THE SLIDE IS
PREPARED AND THE SITE OF THE LESION ON
FROSTED END OF GLASS MICROSCOPIC SLIDE.
>INSTRUMENT:
THE INSTRUMENT USED TO REMOVE THE
SUERFICIAL CELL MUST HAVE A SQUARE EDGE
WITH A CONTOUR SUFFICIENT TO SCRAPE OFF
THE SUPERFICIAL LAYER OFCELLS. WHAN THE
LESION IS VERY SMALL , THE EDGE OF THE
TOOTH PICK IS EFFECTIVE.

>CLEARING OF SURFACE:
CLEAR THE SURFACE OF ORAL LESIONS
WITH DEBRIS AND MUCUS.
>SCRAPING THE TISSUES:
WHILE THE TISSUE IS STRECHED, THE
SQUARED EDGE OF THE COLLECTION
INSTRUMENT IS POSITIONED AT THE BACK OF
THE LESIONS AND IS FIRMLY HELD AND
BROUGHT FORWARD AND PRESSURE APPLIED
UNTIL VISIBLE MATERIAL IS COLLECTED.
VIGOROUS SCRAPING OF ENTIRE SURFACE
OFTHR LESION SEVERAL TIME IS DONE WITH A
METAL CEMENT SPATULA OR A MOISTENED
TONGUE BLADE.

>SPREADING OF MATERIAL ON SLIDE:

COLLECTED MATERIAL IS THEN QUICKLY
SPREAD EVENLY ON THE MICROSCOPIC SLIDE.
>FIXING OF TISSUES:
FIX IT IN COMMERCIAL PREPARATIONS
SUCH AS SPRAYCYTE, 95% ALCOHOL OR EQUAL
PART OF ALCOHOL AND ETHER, IMMEDIATELY
BEFORE IT DRIES. THEN ALLOW IT TO STAND IT
FOR THIRTY MINUTES SO THAT IT AIR DRIES.

>REPEAT:
REPEAT THE PROCEDURE AND PREPARE A
SECOND SMEAR.
 INTERPRITATION

IT IS REPORTED BY A CYTOLOGIST AS FOLLOWS

INTO ONE OF THE FOLLOWING CLASSES
 CLASS 1 (NORMAL): IT INDICATES THAT
ONLY NORMAL CELLS ARE OBSERVED.
 CLASS 2 (ATYPICAL): PRESENCE OF MINOR
ATYPIA BUT NO EVIDENCE OF MALIGNANT
CHANGES.
 CLASS 3 (INTRMEDIATE): THIS IS A STAGE
IN BETWEEN THAT OF CLASS 2 AND 4 AND
SEPERATES NON CANCER CELLS FROM
CANCER CELLS DISPLAYING WIDER ATYPIA
THAT MAY BE SUGGGESTIVE OFCANCER BUT
THEY ARE NOT CLEAR CUT AND MAY
REPRESENT PRE CANCEROUS LESIONS OR
CARCINOMA IN SITU ANDBIOPSY IS
RECOMMENDED IN SUCH CASES .
 CLASS 4 (SUGGESTIVEOF CANCER): FEW
CELLS WITH MALINGNANT
 CHARACTERISTIC OF MANY CELLS WITH
BORDERLINE FEATURES. BIOPSY IS
MENDATRORY IN SUCH CASES.
 CLASS 5 (POSITIVE OF CANCER): CELLS
THAT ARE OBVIOUSLY MALINGNANT.
BIOPSY IS MENDATORY IN SUCH CASES.

REFRENCES
NEVIL
SHAFFERS 12TH EDITITON
(ORAL PATHOLOGY)
ANIL GOVIND GHOOMS 2ND EDITION
(ORAL MEDICINE)