Exfoliative Cytology is a branch of cytopathology that involves the study of cells shed (exfoliated) from body surfaces or cavities to detect diseases — especially cancer and precancerous lesions.
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🔬 Definition:
Exfoliative cytology is the microscopic examination of cells that are naturally shed or artificially removed (by scraping, brushing, or washing) from epithelial surfaces.
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📍 Types of Exfoliative Cytology:
1. Spontaneous exfoliation:
Cells are naturally shed into body fluids.
Examples:
Sputum (for lung cancer detection)
Urine (for bladder cancer detection)
Pleural or peritoneal fluids
2. Artificial exfoliation:
Cells are removed manually for examination.
Examples:
Pap smear (cervical cytology)
Brush cytology from bronchi or stomach
Scrape cytology from oral cavity or skin
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⚙️ Common Techniques:
Pap smear (Papanicolaou test): Cervical screening to detect cervical cancer and dysplasia.
Bronchial brushing/washing: For respiratory tract lesions.
Urine cytology: For urothelial carcinoma.
Body fluid cytology: Pleural, pericardial, peritoneal fluids.
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🧫 Processing and Staining:
Fixation: 95% ethanol (to preserve cellular detail)
Staining:
Papanicolaou stain (Pap stain) – routine stain for exfoliative cytology
Hematoxylin and eosin (H&E) – occasionally used
Special stains – if infection or special substances are suspected
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🔍 Applications:
Early detection of cancers (especially cervix, lungs, urinary tract)
Detection of infections (e.g., Candida, HSV)
Assessment of hormonal status
Screening tests in mass health programs
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⚠️ Advantages:
Simple, non-invasive
Rapid and cost-effective
Useful for screening and diagnosis
❌ Limitations:
May yield false negatives (due to poor sampling)
Limited information about tissue architecture
Requires experienced cytopathologist for accurate interpretation
🧫 Artificial Exfoliation (in Cytology)
Definition:
Artificial exfoliation refers to the collection of cells that are deliberately removed from body surfaces or cavities using mechanical methods such as scraping, brushing, or washing — instead of waiting for them to shed naturally.
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⚙️ Purpose:
To obtain representative epithelial cells from specific areas that do not naturally exfoliate well, allowing early detection of cancer, precancerous changes, and infections.
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🩸 Common Methods of Artificial Exfoliation:
1. Scrape Cytology
Cells are collected by scraping the surface using a spatula or glass slide.
Example:
Pap smear (cervical scrape cytology) – to detect cervical cancer or dysplasia.
Oral cavity scrape – for oral cancer screening.
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2. Brush Cytology
A cytobrush or nylon brush is used to brush the epithelial surface to obtain deeper cells.
Examples:
Bronchial brushings – for lung lesions.
Gastrointestinal brushings – for stomach or esophageal lesions.
Bile duct brushings – for detecting biliary malignancies.
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