Basic Diagnostic Cytology

BASIC DIAGNOSTIC
CYTOLOGY
Rene J.A.R. Dinglasan

March 3, 2010
BASIC DIAGNOSTIC CYTOLOGY
 Microscopic examination of cells from different
body sites
 Divisions:
– Exfoliative cytology
– Fine Needle Aspiration (FNA)
Exfoliative cytology
 Microscopic study of cells that have been
desquamated from epithelial surfaces
 Recommended for:
– Detection of malignant cells
– Detection of precancerous cervical lesions in women
– Assessment of female hormonal status in cases of
sterility and endocrine disorders
– Determination of genetic sex – Barr bodies
– Detection of infectious agents
Exfoliative Cytology
 Sources of exfoliated cells:
– Vagina
– Buccal mucosa
– Sputum
– Urine
– Pleural fluid
– Ascitic fluid
– Gastric fluid
– CSF
 Collection and Preparation of Specimen:
1. Pap smear (cervicovaginal smear)
2. Nipple discharge
3. Gastric or bronchial secretions
4. Pleural and peritoneal fluids
5. Sputum
6. Urine sediment
7. Cerebrospinal fluid
 Fixation
A.) Fluid specimen
- Fixatives:  50% alcohol (all types of effusion)
50% alcohol – pleural and peritoneal fluids
70% alcohol – sputum
95% alcohol – urine, bronchial and gastric aspirates
 Saccomano’s fixative (50% ethanol and 2% carbowax)
- Centrifugation:
 2000 rpm for 2 mins.
 supernatant  decanted
 sediment  smeared
 sediment  smeared
- directly to glass slide
- cytospin on slides with
egg albumin
 extra sediment  cell block technique
-filtration mtd.
-plasma-
thrombin mtd.
- Carbowax mtd.
 Fixation
B.) Smears
- Avoid drying of smears!
- Fixatives: Equal parts of 95% ethanol and
ether – BEST
95% ethanol – COMMONLY
USED
*spray fixative  slide should be kept at a
distance of 1 foot from the spray
 Precautions during fixation:
1. Identify the slides before preparing smears.
2. Use paper clips to the identified end of the slide
before preparing smears.
3. Smears should be placed into the fixative
container immediately after preparations.
4. Place each smear in fixative by a single
uninterrupted motion to avoid rippling of smeared
material.
5. Avoid striking the bottom of the fixative
container forcefully to prevent dislodging the
cells.
 Non-gynecologic Specimens
– Respiratory tract specimens
– Gastrointestinal specimens
– Peritoneal, pleural, pericardial fluids
– Smears of breast secretion
– Urine
– Cerebrospinal fluid
 Gynecologic Specimens – Pap smears
Respiratory tract specimens
 Types of specimen
1. Sputum
2. Bronchoalveolar lavage/bronchial washings (BAL)
3. Bronchial brushings
4. Bronchial aspirates
Sputum
 Obtain at least 3 consecutive morning sputum
specimens(through deep cough)
 Use wide-mouthed jar w/ Saccomano’s fixative.
 Sputum induction – inhalation of aerosol solution
for 20 mins.
 Alveolar macrophages – sputum from deep
cough
 Absence of alveolar macrophages – saliva
Bronchial brushings
 Specimen is directly smeared onto 2 labeled
slides by pull technique.
 Fix the slides immediately.
 Failure to fix the slides within a few seconds will
produce air drying artifacts.
Bronchial lavage/washings
 Performed in patients with AIDS to rule out
Pneumocystis carinii.
Gastrointestinal Specimens
 Collection is usually done to exclude the
possibility of malignant tumors
 Types of specimen:
– Gastric lavage
– Gastric brush
– FNA (for submucosal lesions)
Gastrointestinal specimens
 Any delay of more than ½ hour before fixation

will digest the cells.
 Patient should fast for at least 8 hours before
gastric washing.
Peritoneal, pleural and pericardial fluids
 Jelly-like clots forming after removal may be

prevented by adding 300 units of heparin per
100 mL of aspirate
Urinary tract specimen
 Major goal: diagnosis of urothelial malignancy
 Prostatic carcinomas are rarely found in urinary
specimens.
 At least 50 mL is needed.
 First voided urine should be discarded (overnight
degeneration of cells)
 Second urine is preferred.
 Use of preservatives is not recommended.
 Types of specimens:
– Voided urine (for males)
– Catheterized specimen (for females) – to prevent
contamination with vulvar cells
– Washings from bladder or renal pelvis

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BASIC DIAGNOSTIC

Rene J.A.R. Dinglasan

 Any delay of more than ½ hour before fixation

 Jelly-like clots forming after removal may be

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