Exfoliative cytology examines cells that have been shed from epithelial surfaces under a microscope. It can detect malignant or precancerous lesions, assess female hormonal status and detect infections. Specimens include cervical smears, body fluids, nipple discharge, bronchial brushings, sputum, gastric lavage and urine. Proper collection and transport methods are outlined for various specimen types. Cervical cancer screening via cervical smear is important for early detection since most cases are diagnosed at late stages when treatment is difficult. Fixation and Pap staining procedures are described to preserve cell structure and differentiate cell types under the microscope.

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-
1. Detection of malignant cells or precancerous lesion.
2. Detection of asymptomatic or pre cancerous cervical lesion in women.
3. Assessment of female hormonal status in case of sterility.
4. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. Cervicovaginal smear
Ayre’s spatula

12. Ayre spatula (plastic)

16. 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 –
1. 95% ethanol
2. 100%methanol
3. 95% rectified spirit
4. 80% isopropanol
5. Spray fixative contain isopropanol and propylene glycol.

17. 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)

18. Procedure