EXFOLIATIVE CYTOLOGY

This is the study of cells which are spontaneously shed off from epithelial surfaces into body cavities or
fluid. The cells can also be obtained by scraping, brushing or wash of body surfaces. The principle of this
technique is that in diseased states, rate of exfoliation of cells is increased.

Applications of Exfoliative Cytology

Exfoliative cytology is applied in diagnosing diseases of the following:

1. Female genital tract
2. Respiratory tract
3. Gastrointestinal tract
4. Urinary tract
5. Body fluids (pleural, peritoneal, pericardial, CSF and semen)
6. Buccal smears for sex chromatin

Female Genital Tract Smears from female genital tract are known as ‘Pap smears’.
These smears are prepared by different methods depending upon the purpose for which they are
intended
i. Cervical smear

It is obtained by Ayre’s spatula from portio of the cervix by rotating the spatula through 360o to sample
the entire cervix. The scraped material is placed on a clean glass slide and smear prepared. It is ideal for
detection of cervical carcinoma.

ii. Lateral vaginal smear (LVS) is obtained by scraping upper third of lateral walls of the vagina and is
ideal for cytohormonal assessment.

iii. Vaginal pool smear is obtained by aspirating material from posterior fornix of vagina and is done for
detecting endometrial and ovarian carcinoma.

Respiratory Tract Material from respiratory tract may be obtained during bronchoscopic procedures as
expectorant (sputum), or by brushing (BB), washing (BW) and bronchioalveolar lavage (BAL). Sputum
examination is advantageous as samples are easily obtained and cellular content is representative of
entire respiratory tract. At least three samples of sputum, preferably early morning samples, should be
examined.

Gastrointestinal Tract Lesions in the oral cavity can be sampled by scraping the surface with a metallic
or wooden spatula. Samples can be obtained from the oesophagus, stomach, small and large intestine
either by brushing or lavage during fibreoptic endoscopy.

Urinary Tract Samples from lesions in the urinary tract are either urinary sediment examined from
voided urine/ catheterised urine or washings of the urinary bladder obtained at cystoscopy.

Body Fluids Fluid from pleural, peritoneal or pericardial cavity is obtained by paracentesis. At least 50-
100 ml of fluid is aspirated. The sample is examined fresh but if delay is anticipated then fluid should be
anticoagulated either in EDTA 1 mg/ml or 3.8% sodium citrate 1ml/10ml. Fluid should be centrifuged
and smears are prepared from the sediment. If amount of fluid is less (less than 1 ml), then it can be
subjected to cytospin centrifuged smear preparation

Buccal Smears for Sex Chromatin Smears are prepared from the oral cavity after cleaning the area.
Vaginal smears can also be used. In normal females, Barr bodies are present in 4-20% nuclei. In males
their count is in less than 2% nuclei.

ASPIRATION CYTOLOGY In this study, samples are obtained from diseased tissue by fine needle
aspiration (FNA) or aspiration biopsy cytology (ABC).

Applications of FNA FNA or ABC is applied for diagnosis of palpable as well as non-palpable lesions.

I. Palpable Mass Lesions in:

1. Lymph nodes
2. Breast
3. Thyroid
4. Salivary glands
5. Soft tissue masses
6. Bones
II. Non-Palpable Mass Lesions in:
1. Abdominal cavity
2. Thoracic cavity
3. Retroperitoneum
Procedure for FNA Materials For performing FNA,
a Franzen’s handle,
syringe with needles,
clean glass slides and
suitable fixative are required Method
No anaesthesia is required.
Ask the patient to lie down in comfortable position exposing the target area. „ Palpate the target area. „
Clean the overlying skin with spirit. „ Fix 10/20 ml disposable syringe in Franzen’s handle. Insert 20-25
gauge disposable needle into syringe „ Fix the mass by palpating hand and insert needle into target area
Apply suction while moving needle back and forth within the lesion and change the direction of the
needle. Terminate the aspiration when aspirated material or blood is visible at the base/hub of the
needle. „ Release the suction before withdrawing the needle to equalise pressure within the syringe. „
After withdrawal of needle, apply pressure for 2-3 minutes at the site of puncture to arrest bleeding and
prevent haematoma formation. „ Aspirated material from the needle is expressed on to clean glass
slides by first detaching the needle and filling the syringe with air and expressing it with pressure. „
Smears are prepared as for blood smears. If the material is semi-solid, it is first crushed by gentle
pressure with a glass slide and smears prepared .„ Fixation and staining are the same as for exfoliative
cytology.

Radiological Imaging Aids for FNA

Non-palpable lesions require some form of localisation by radiological aids for FNA to be carried out.
Plain X-ray is usually adequate for lesions in bones and chest. Ultrasonography (USG) allows direct
visualisation of needle in intra-abdominal and soft tissue masses. CT scan can be used for lesions in
chest and abdomen.

Advantages of FNA over Surgical Biopsy

i. Outdoor procedure
ii. No anaesthesia required
iii. Results obtained within hours
iv. Procedure can be repeated
v. Low cost procedure