This cellular material is either :

- Spread directly on a glass slide and immediately preserved by the use of a spray fixative or immersed in alcohol.

- Deposited in a tube containing a preservative solution for the purpose of a single layered preparation.

- If the material is abundant and liquid in form, it is collected in a tube or a receptacle of a relatively large size and sent to the laboratory where it will be centrifuged. The cells are thus concentrated and processed in accordance with one of the methods mentioned above.

This evaluation allows not only the analysis of the cells from malignant tumors but also certain benign conditions which are essential for the management and treatment of patients. It is also possible to identify the precancerous lesions of certain cancers especially those related to the female genital tract, where mass screening of the general population is of utmost importance. Cytology also has the added task of recognizing certain microorganisms causing infections.

The quality of the cytologic material may however limit this interpretation. In effect, the cells spread directly on the slides are sometimes air-dried since the cells are by nature very fragile and degenerate quickly once removed from the physiological milieu. It is imperative therefore to " fix " the specimen with at least a spray fixative or alcohol, unless a special staining procedure (MGG, immunochemistry ) is required. The cells at times can also be obscured by blood or white blood cells (which stain dark or black) or the cells can be superimposed and poorly spread. The smear however has the advantage of preserving the " background " of the original site of the cells in sufficient detail to facilitate the identification of certain lesions (eg : adenocarcinoma of the endometrium) even in the absence of the cells in question!

On the other hand, specimens processed by the single layer method have a " cleaner " background. The cellular morphology is generally easier to view. Nevertheless, experience is required to identify cells from certain lesions especially those arising from high-grade squamous intra-epithelial lesions of the cervix since these cells have a tendency to be small and isolated. A cervical smear contains on average 100,000 cells that must be examined for any abnormality thus requiring a high degree of concentration. In accordance with lab requirements, the cytotechnologist must therefore " screen " and render a cytodiagnosis of quite a large number of specimens, be it gynecological or non-gynecological. He or she must have a knowledge of specimen preparation and at times be prepared to assist the pathologist in procuring the specimen, as is the case with fine needle aspirations. Other techniques such as flow cytometry, immunochemistry, fluorescent and special stains allow differential staining of malignant lesions and specification of the cellular origin. In addition to the foregoing, the cytotechnologist must become computer literate, follow-up positive cases, participate in quality control, and must order supplies and carry out related laboratory duties.

Cytotechnology therefore is a profession which requires diversity even though a large part of the working day is spent with eyes fixed on the microscope, in order to identify the least cellular anomaly and render a diagnosis of a specific lesion or benign condition. For this reason, it is essential to work with a microscope of optimum quality i.e. a microscope with quality optics, in a work environment which is ergonomically designed. With all the technological advances, one may ask if the cytotechnologist (will or) can be replaced by automated technology which will screen 24 hrs/24hrs. This automated technology has been used in the United States and in Europe for quite some time now, in the capacity of quality assurance i.e. the review of smears already screened by cytotechnologists. It has also been shown useful in the teaching of cellular morphology where cells of interest are recorded by automation and such information can be retrieved at any time. It is essential however, to standardize the method of specimen preparation of cells must be spread in single layers, with staining procedures that can be perfectly duplicated. In contrast to automation, the human eye easily adapts to subtle variations and can recognize numerous subtilities allowing the most sophisticated of diagnoses. Among all the laboratory medical fields, cytology is the only such paramedical field where it is possible to render a diagnosis. It is, however, not yet recognized as a profession. Cytology is usually a substrate of a larger medical laboratory degree, and even then it is considered a subspecialty. In conclusion, cytology is a young profession, well suited to technical advances and is evolving rapidly while still in an early phase of its evolution.