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CYTOLOGY

GENERAL INFORMATION

SUBMISSION REQUIREMENTS:

           1.  All fluid specimens must be submitted in a properly labeled container to include the patient's name, FMP, SSN, LMP and type of specimen.  All slides prepared by clinics or wards must be identified by writing the patient's name and SSN on the frosted end with a #2 lead pencil.   Additionally, the slide must be adequately fixed by spray fixation or immersing the slide in alcohol.

           2.  Requests:  All GYN PAP specimens must be entered into CHCS. All fine needle aspirations should include patient identification, four digit UCA Codes, the route of approach to the target mass and requesting physicians name, clinic, patient history, patient age and type of specimen, entered in CHCS as a “non-gyn” specimen.

           3.  All specimens requiring RUSH status must be clearly and legibly noted RUSH in RED ink. Any questions should be addressed to the Cytology Section, 6/7306/6/7308.

           4.  Improperly labeled specimens or specimens not ordered in CHCS will will not be processed until the submitting service makes the appropriate corrections. 
 

DELIVERY OF SPECIMENS:

           1.  Specimens obtained during duty hours, should be delivered directly to the Histology Laboratory.  During non-duty hours, non-fixed specimens should be obtained only if absolutely necessary and should be immediately delivered to the Clinical Lab for refrigeration.  Heparin (3u/ml) must be immediately added to any body fluid specimen (other than CSF or urine) to prevent clotting and to inhibit degeneration.

           2.  All non-GYN specimens received by 1400 hours will be processed on the same day with results ready the next day.  Those received after 1400 hours will be refrigerated in the Histology Laboratory and processed on the following work day. 
 

FIXATION:

           1.  Cellular smear preparations (cervicovaginal, conjunctival, bronchial brushings, nipple discharge, etc.) require immediate fixation in 95% ethanol or pap fixative to eliminate drying artifact.  Please do not put in buckets with Pap stains.

           2.  Consultation should be obtained from a Staff Pathologist prior to performing a fine needle aspirate.  If not performing aspirate, Pathology will assist with collection of specimen.  Often a combination of air-dried and ethanol fixed slides are recommended.

           3.  Expectorated specimens (sputum) are to be sent in a container with 40-50 cc of 70 % ETOH, obtained from the Cytology Section, or placed in Saccomanno’s fixative (50cc). During non-duty hours, an equal volume of Saccomanno’s should be added to body fluid specimens, except CSF and pleural fluids, which can be refrigerated overnight.  Saccomanno’s fluid can be obtained in the lab during duty hours.

           4.  All other routine cytologic specimens (body fluids, urine,  bronchial washings, etc.) require no fixative and should be sent immediately to the Histology Laboratory for processing during duty hours.  To avoid clotting and inhibit degeneration, body fluid specimens, not including CSF, heparin should be immediately added in the ratio of units of heparin per ml of fluid.

           5.  If a question arises as to how a specimen should be handled, please call Cytology at 526-7309 or 6-7306. 
 

SPECIAL PROCEDURES:

           1.  Breast Specimens (Nipple Discharge and Needle Aspirates):

                 a.  Smear of nipple discharge should be fixed immediately in 95% ethanol or pap fixative.

                 b.  Aspiration specimens - Cyst fluid should be submitted unfixed to the Histology Laboratory during duty hours.  Immediate addition of heparin (1000 units per 100 ul) will decrease degeneration and prevent clotting.  Non-duty hours add equal volume of cyto-fixative (Saccomanno's), no alcohol.

           2.  Buccal Smears:  Call Cytology Section at 526-7309 or 6-7306 to schedule an appointment.

           3.  Cerebrospinal Fluid:  Send a sample to the Clinical Pathology Laboratory, Hematology Section for a cell count and differential white cell count based on a cytospin preparation.  If cytologic evaluation is requested during duty hours, a separate specimen with order in CHCS for non-gyn should be submitted to the Histology Laboratory.  During non-duty hours, the specimen should be submitted to the Hematology Section for immediate processing and refrigeration.

           4.  Fine Needle Aspirates (FNA):  Coordinate scheduling with the Staff Pathologist.  Pathology will perform the procedures in clinics or on the wards on both a scheduled and on-call basis.  If aspiration of the specimen is to be done by your service, Pathology prefers to be consulted for assistance in collecting the specimen.  In all cases, a preliminary opinion and/or assessment of specimen adequacy can be rendered by the Pathologist while the patient is still prepped.  Aspirates requiring radiologic guidance need to be scheduled with Radiology.  Pathology will assist the Radiologist in obtaining the specimen.

           5.  Esophagus Washings:

                 a.  During direct esophagoscopy, rinse the lesion with 10-20 ml of physiologic, balanced salt solution.  Aspirate solution into container, pack in ice and deliver specimen directly to Histology Laboratory.

                 b.  Brushings:  Brush any visible lesions and smear samples on clean glass slide labeled with patient's name and specimen source.  For a single slide specimen, immerse in 95% ethanol immediately.  If more than one slide is prepared, immerse half the slides in 95% ethanol and air dry the other half.  Clip disposable brush and place in physiologic fluid contained in clean cup labeled with patient's name and specimen source.  Deliver immediately to Cytology service.  If there is to be a delay, immerse brush in 95% ethanol.

           6.  Gastric Washings:

                 a.  Give the patient a soft meal the night before and water ad lib until one hour before the procedure.  Pass a number 18 Levin's tube, aspirate and discard the gastric fluid.  Instill 500 cc of physiologic, balanced salt solution using a 100 cc syringe.  Have the patient roll on his right side, back and left side.  In each position lavage stomach vigorously several times.  Ballotte stomach.  Empty stomach and place fluid in flask packed in ice.  Deliver the specimen directly to the Histology Laboratory without fixative.

                 b.  Utilize same procedure as for esophagus.

           7.  Pap Smear (Female Genital Tract):

                 a.  Obtain cervical scraping and brushing from complete squamocolumar junction.  Spread smear quickly across slide and fix immediately with PAP Fixative.

                 b.  For evaluation of adenosis, the cervix and vagina should be free of mucus before smears are made.  If four quadrant vaginal smears are submitted, each slide should be labeled as to site.

                 c.  For a hormonal maturation index, the sample should be taken from the lateral wall of the vagina, not in combination with cervical smear.

           8.  Pulmonary Specimens:

                 a.  Bronchial Washings:  Position the patient so that the bronchus in question is dependent.  Fill the bronchus with physiological balanced salt solution.  Aspirate and reinstill the solution several times.  Aspirate all the fluid from the bronchus, and send immediately without fixative to the Histology Laboratory.

                 b.  Bronchial Brush Specimens:  Utilize procedure under esophageal brushings.

                 c.  Post-bronchoscopy Sputum:  This is the most valuable pulmonary specimen!  Give the patient a sputum cup before the bronchoscope is withdrawn.  Collect in 40-50 ccs of 95% ETOH or Saccomanno's.  Continue the routine sputum series.

                 d.  Sputum:  The evening prior to specimen collection, the patient should be given a clean specimen cup and instructed as to the proper technique.  On first awakening in the A.M., the patient should rinse with water, cough deeply, (from the diaphragm) and expectorate all sputum into the specimen cup.  Encourage the patient to expectorate sputum...not SALIVA.  The patient continues the deep coughing and expectorations until the cup is collected.  Specimens obtained later in the day are of little diagnostic value.  NOTE:  Saliva is of no diagnostic value and should not be included in the specimen.  Sputum should be fixed with 40-50 ccs of 95% ethanol or Saccamano's fixative.  For maximum diagnostic accuracy, repeat for three to five consecutive days.  Induced sputum samples can be arranged through Respiratory Therapy.

           9.  Urine:  Specimens should be submitted as fresh as possible since cells degenerate rapidly in urine.  The CHCS request must indicate the method of collection, e.g., voided, catheterized or washings and all patient history related to bladder, etc.  Routine technique is to have patient drink one glass of water ever 15 minutes for two-three hours.  At the end of two hours, have patient void and save specimen.  Bring immediately to laboratory.  Repeat for five consecutive days for maximal yield.  Do NOT submit the first morning voids as these specimens are often degenerated.

           10.  Tzank Preparation (surgeries from skin or mucosa for herpes virus infection):  Cut about 3/4 of the way around the vesicle in a "toilet lid" formation.  Flip lid, scrape under side of roof of vesicle with blade and gently smear on clean glass slide.  Be sure slide is labeled with patient's name and specimen source.  Scraping of base of vesicle is much more painful for patient and does not have a better yield of cells.  Either air dry or immediately immerse in 95% ethanol or spray with pap fixative.  Place order in CHCS as non-GYN cytology and indicate whether air dried or alcohol fix.

           11.  Any specimen amenable to cytological study will be accepted by the section.  Unusual cases should be coordinated with the Staff Pathologist.  If questions arise as to how a specimen should be handled, please call the Cytology Section or a Staff Pathologist.

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