Manual for Cytology - IARC Screening Group

Collection and Preparation of Material for Cytodiagnosis
Oesophagus
Oesophageal washing and brushing are usually recommended for collecting cytology sample
from oesophagus. To collect a good specimen for cytology one should first localize the
suspicious lesion by oesophagoscopy .
Stomach
Cytology specimen can be collected from the surface of the lesion by scraping (abrasion)
under direct vision of a flexible endoscope. The cells collected can be directly smeared on
a glass slide. Gastric lavage is also recommended for cytological investigations.
Discharge from nipple of the breast
Spontaneous nipple discharge and discharge produced by breast massage are collected
by applying the slide directly to the nipple followed by immediate fixation.
B. FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)
Procedure, Preparation and Preservation:
FNAC is the study of cellular samples obtained through a fine needle under negative pressure.
The technique is relatively painless and inexpensive. When performed by well-trained
pathologists / surgeons / clinicians and reported by experienced pathologists, it can provide
unequivocal diagnosis in most of the situations.
It is useful in lesions that are easily palpable, like growth of skin, subcutaneous soft tissue
tumours, thyroid, lymph nodes, salivary glands and breast. Guided aspiration by internal
imaging techniques like C.T or ultrasonography allows FNA of lesions of internal organs
like lung, mediastinum, abdominal and retroperitoneal organs, prostate etc. The low risk of
complications allows it to be performed as an out-patient procedure. It is highly suitable in
debilitated patients, multiple lesions and easily repeatable.
The three pre-requisites for a meaningful diagnosis on FNAC are:
1. Proper technique - procedure, preparation of smears, fixation, staining.
2. Microscopic evaluation of smears.
3. Correlation of morphology with the clinical picture
(history, clinical features, radiological and laboratory findings).
The Technique: Attention to technique is necessary to optimize the yield of the sample,
making its interpretation easier and more reliable. Expertise regarding the technique comes
from constant practice and correlation of the smear technique with the results (feedback).
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