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Impression Cytology of the Lid Wiper Area
Published on: August 9, 2016
Aspiration cytology of the conjunctival surface
Hans E Grossniklaus1, R Doyle Stulting, Ted Gansler
1Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Conjunctival aspiration cytology effectively obtains diagnostic cells from eye surface lesions. This method aids in guiding biopsies for accurate diagnosis of conditions like conjunctival intraepithelial neoplasia.
Area of Science:
- Ophthalmology
- Cytopathology
- Oncology
Background:
- Conjunctival lesions require accurate diagnosis for effective management.
- Traditional biopsy methods can be invasive and may require specialized techniques.
- Developing minimally invasive diagnostic tools for ocular surface diseases is crucial.
Observation:
- A novel aspiration technique using a needleless tuberculin syringe was employed on 18 eyes with epibulbar lesions.
- Conjunctival cells were collected and prepared using cytocentrifuge or Millipore filter methods.
- Cytologic diagnoses were compared with subsequent histologic findings from biopsies.
Findings:
- The aspiration cytology method demonstrated a high correlation with histologic diagnoses for various conjunctival lesions, including conjunctival intraepithelial neoplasia, squamous cell carcinoma, and nevus.
- In two instances, cytologic findings correctly guided the subsequent histologic diagnosis.
- Common diagnoses included conjunctival intraepithelial neoplasia, squamous cell carcinoma, and squamous metaplasia.
Implications:
- Conjunctival aspiration cytology is a valuable tool for obtaining diagnostic material from the ocular surface.
- This technique can serve as a preliminary diagnostic guide, informing the optimal site for biopsy.
- Further refinement and experience may overcome limitations such as inadequate sample size and observer variability.
Objective:
To evaluate a method of obtaining conjunctival cells that utilizes aspiration of the conjunctival surface.
Study Design:
Eighteen eyes from 16 patients with epibulbar lesions underwent aspiration of the conjunctival surface using a tuberculin syringe without a needle. The aspirated cells were prepared by the cytocentrifuge or Millipore filter technique. The lesions were subsequently biopsied, and the cytologic and histologic diagnoses were compared.
Results:
Diagnoses of the conjunctival lesions, in decreasing order of frequency, were conjunctival intraepithelial neoplasia (dysplasia, carcinoma in situ), squamous cell carcinoma, squamous metaplasia, nevus, lymphoma and inflammation. In this feasibility study, the cytologic diagnosis accurately correlated with the histologic diagnosis in most cases. There were two cases in which the cytologic diagnosis led to the correct histologic diagnosis.
Conclusion:
Aspiration cytology of the conjunctival surface is useful in obtaining diagnostic material and may be used as a guide to where a biopsy should be performed. Limitations include inadequate samples and lack of observer experience.
