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

12. THANK YOU