|
Cytopathology Services for Community-General Hospital
Specimen Labeling:
All specimen containers and slides must be labeled with the patient's name and specimen source. Containers should additionally include the patient's social security number, and the date and time collected. Slides should be labeled in pencil, as our processing reagents will dissolve ink.
The specimen should be accompanied by a cytology requisition form. This form should be completed to include pertinent patient history, especially history of previous malignancy, treatment with chemotherapy or radiation therapy, and significant clinical findings such as the presence of a mass lesion. Multiple samples representing different body sites must each be accompanied by a separate requisition form.
GYN (Cervical/Vaginal) Cytology:
The patient should not be menstruating when the smear is collected; have had sexual relations within 24 hours before specimen collection; or have douched within 24 hours before specimen collection.
The examiner should sample the squamocolumnar junction (T-zone). Use of broom-type devices or combined use of Ayre spatula with cytobrush are acceptable methods of sampling.
Collecting exfoliated cells from the vaginal pool is desirable in postmenopausal women, as it improves the chance of detecting endometrial carcinoma.
The specimen should be spread evenly across the glass slide and immediately immersed in 95% alcohol (available from the cytology section). Alternatively, the specimen can be spray fixed with cytology fixative. For Thin Prep Pap tests, the collection device should be rinsed directly into a vial of Preserv-Cyt solution, available from the cytology section.
It is important not to contaminate the specimen with lubricant.
Rejection of Specimens:
A diagnostic report will not be issued if:
1. The apparent condition of the specimen indicates that it is unsatisfactory for testing or that
it is inappropriate for test requested.
2. It has been collected, labeled, preserved or otherwise handled in such a manner that it has
become unsatisfactory or unreliable as a test specimen.
3. The slide is broken to such an extent that it cannot be repaired adequately so that cells are
not obscured or lost.
4. It contains insufficient cells or the cells are obscured by inflammation, blood, or lubricating
ointment, so that an accurate diagnosis cannot be made.
Non-GYN Cytology:
1. Includes urine, body fluids, washings, brushings, and fine needle aspiration cytology.
Urine Cytology:
1. Voided urine, catheterized urine, bladder washings, ureteral washings, and renal pelvic
washings.
2. Send specimen in clean, leak-proof container. At least 50 ml. of specimen is needed for
optimal processing.
3. No fixative should be added.
4. Deliver to Cytology lab immediately. May be stored in refrigerator overnight.
5. Urine cytology should be avoided on the weekend, as the cells tend to degenerate after
24 hours.
6. First morning voided urine should not be sent, as the cells tend to degenerate while sitting in
the bladder overnight.
Body Fluids:
1. Includes pleural fluid, thoracentesis fluid, ascites, paracentesis, pelvic washings,
culdocentesis, peritoneal fluid, pericardial fluid, and synovial fluid.
2. Send specimen in a clean, leak-proof container. At least 5 ml. of specimen is needed for
optimal processing.
3. No fixative should be added.
4. Deliver to Cytology lab immediately. May be stored in refrigerator over the weekend if
necessary.
Brushings:
1. Includes bronchial brushings, esophageal brushings, gastric brushings, small bowel
brushings, colonic brushings, and bile duct brushings.
2. Roll brush over a labeled glass slide to cover the area of a dime, and drop immediately
into 95% acid alcohol (available from the cytology section).
Washings:
1. Includes bronchial washings and BAL fluid.
2. Send specimen in clean, leak-proof container. At least 2 ml. of specimen is needed for
optimal processing.
3. No fixative should be added.
4. Deliver to the Cytology lab immediately. Specimen may be stored in the refrigerator for up
to 24 hours.
Sputum:
1. A deep cough specimen, preferably early in the morning, is recommended. At least 3 ml. of
specimen is needed for optimal processing.
2. Place in a clean sputum container.
3. No fixative should be added.
4. Deliver to Cytology lab immediately. Specimen may be stored in refrigerator for up to
24 hours.
5. Three consecutive first morning sputum specimens are recommended to significantly
increase the chance of cancer detection.
Cerebrospinal Fluid:
1. Place in sterile tube or leak-proof container.
2. At least 1 ml. of specimen is needed for optimal processing.
3. No fixative should be added.
4. Deliver to Cytology lab immediately. Specimen may be stored in refrigerator for up to
24 hours.
Nipple Discharge Cytology:
1. Allow a pea-size drop to accumulate on nipple. Place a labeled glass slide on nipple and
slide across quickly. Fix immediately in 95% acid alcohol (available from the cytology
section).
Fine Needle Aspiration Cytology:
1. Preparation and interpretation of aspirates is performed Monday through Friday, from
8:00 a.m. to 3:00 p.m.
2. These specimens receive priority attention, and every effort will be made to provide a
turn-around-time of 24 hours.
3. Aspirates are not processed or interpreted on evenings/weekends.
4. The contents of the needle must be injected into a vial of Cytolyt solution (available from the
cytology section). Flush the needle with the Cytolyt solution from the container until the
entire contents of the needle have been expelled into the Cytolyt container. If a second
pass is to be attempted, the needle must be changed. Do not attempt to re-aspirate with
the same needle. The Cytolyt contains methyl alcohol which is poisonous.
5. The Cytolyt vial containing the specimen is then sent to the Cytology laboratory for
processing.
6. Alternatively, the specimen may be expelled from the needle onto a glass slide. A second
slide an be placed on top of the first slide, the 2 slides are then gently pulled apart and
immediately fixed in 95% acid alcohol (available from the cytology section). The slides
in alcohol are then sent to Cytology for processing.
Quik Read Evaluation of Fine Needle Aspiration Biopsy Specimens:
1. Send an unstained air-dried smear along with a completed Adequacy Form to the Cytology
section.
2. The smear will be stained and reviewed by the pathologist on call to determine the adequacy
of the specimen.
3. The pathologist will call the radiologist to report on the adequacy of the specimen. The entire
process usually takes 10-15 minutes. If the specimen is deemed inadequate, the radiologist
has the option of performing additional passes.
4. Any smears that are not going to be sent for immediate evaluation should be quickly placed in
95% acid alcohol and sent to Cytology with a completed requisition form.
|
