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Cytopathology
Location:	University Medical Office Building 2^nd Floor 2025 Gravier Street
Unit telephones:	504-903-5232, 504-903-5233		Telephone
Director:	Bernardo A. Ruiz, M.D., Ph.D.		504-568-2004
Manager:	Elizabeth Bohrer, CT (ASCP)		504-903-5233
Service hours:	07:30-16:00h, Monday through Friday Closed on weekends and holidays
CYTOPATHOLOGY SPECIMEN COLLECTION The cytopathology laboratory accepts specimens only when collected by credentialed physicians or by licensed nurse practitioners under the auspices of these physicians. Sputum and urine specimens may be collected by patients provided with detailed instructions, under the direction of a physician or a nurse. Supplies such as requisition forms, fixatives and small specimen containers are available on demand at the cytopathology laboratory. For this purpose, please contact the laboratory manager, Ms. Bohrer, at 903-5233. GENERAL RECOMMENDATIONS Fluid specimens, containers - Only break-resistant plastic containers are acceptable as primary specimen containers. - Glass containers pose a biohazard risk and WILL BE REJECTED - Caps in all fluid containers must be checked to make sure that they are secured and leak-proof. Leaking containers WILL BE REJECTED. Fluid specimens, labeling - The primary specimen container must be labeled with patient’s name, medical record number, account number, date of birth, collection date and specimen source. - A minimum of two personal identifiers is required. Fluid specimens, fixation - Fluid specimens ideally should be sent fresh to the cytology laboratory immediately after collection (no fixative is required under these circumstances). - When short delays are anticipated (overnight, one or two-days holidays), fresh fluid specimens should be refrigerated. - When longer delays are anticipated, fluid specimens should be preserved with equal volume of CytoLyt fixative or 95% alcohol. Smears (glass slides), containers - Following fixation, smears on glass slides must be allowed to dry completely and then secured in cardboard mailers before transportation. Smears, labeling - Glass slides must be labeled with the patient's last name and first initial, using a lead pencil or a solvent-fast marker (ordinary ink is erased by solutions used during specimen processing). - If more than one smear is submitted per patient, each slide must be labeled (labeling only one slide is unsatisfactory) - Writing patient's name on cardboard mailer alone is insufficient. - Unlabeled slides WILL BE REJECTED. Smears, fixation - Smears must be sprayed-fixed or immersed immediately in 95% ethanol. - Smears immersed in alcohol may be removed after 15 minutes. - Smears must be allowed to dry before transportation. - Please indicate on the slide the type of fixation used. Requisition forms - A properly completed requisition slip must accompany all specimens. - Use biohazard bags with document pockets to double-contain all specimens; to prevent contamination, place the requisition slip in the document pocket. - Use pink cytopathology slips for “screening” GYN (cervical) specimens. - Use yellow cytopathology slips for “diagnostic” GYN (cervical) specimens. - Use green cytopathology slips for all NON-GYN specimens. - Cytotechnologist and pathologists must complete a Fine Needle Aspiration Consultation Form when they assess or perform a fine needle aspiration. - The patient’s name, date of birth, account number and hospital number must be stamped or affixed on the requisition form. - If it is not possible to stamp/affix this information, it must be clearly written in the designated area. - Providing a STAFF physician name in the requisition form is mandatory. Providing the STAFF physician’s name is required for specimen accessioning and billing. Resident physicians’ names cannot be used for this purpose. The reporting of a specimen lacking a STAFF physician’s name may be delayed until this information is provided. - Provide the service where the specimen is collected, time and date of collection. This information is essential for the assessment of the specimen, reporting and quality control purposes. - Provide a summary of RELEVANT clinical information. Correlation with clinical findings is critical for specimen evaluation. - GYN specimens require date of last menstrual period or menopause/hysterectomy status. - When multiple specimens are obtained consecutively from a single patient, from different locations, they must be submitted separately and labeled accordingly. In these circumstances, please use a separate requisition form for EACH specimen. COLLECTION OF GYN (CERVICAL) SPECIMENS Patient preparation - The mid-cycle is the ideal time for collection of a cervical specimen. - Collecting specimens during menstrual phase should be avoided if at all possible. Specimen - Cells are exfoliated from the ectocervix and the endocervical canal using an appropriate sampling device and put into a ThinPrep vial containing PreservCyt solution. - A broom-like or cytobrush/spatula cervical sampling device can be used. Broom-like device protocol - Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. - Push gently, and rotate the broom in a clockwise direction five times. - Rinse the broom as quickly as possible into the PreservCyt solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart. - Swirl the broom vigorously to further release material. - Discard the broom. Brush/spatula protocol - Obtain an adequate sampling from the ectocervix using a plastic spatula. - Rinse the spatula as quickly as possible into the PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times. - Discard the spatula. - Obtain an adequate sampling from the endocervix using an endocervical brush device. - Insert the brush into the cervix until only the bottommost fibers are exposed. - Slowly rotate 1/4 or 1/2 turn in one direction. DO NOT OVER-ROTATE. - Rinse the brush as quickly as possible in the PreservCyt solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall. - Swirl the brush vigorously to further release material. - Discard the brush. COLLECTION OF SELECTED NON-GYN SPECIMENS Sputums - To obtain satisfactory “deep cough” sputum specimens by natural means, the patient is instructed to inhale air to full lung capacity and exhale with an explosive cough. - It is important to have the patient brush his/her teeth and rinse the mouth before collecting the specimen in order to decrease oral contaminants. - Early morning specimens are preferable. - Three early morning specimens consecutively collected over a 3-day period are ideal. - The sputum is expectorated directly into a wide mouth jar containing CytoLyt fixative. - Only deep cough specimens are satisfactory. - For patients who have no productive cough, aerosol inhalation may help, a request for assistance from Inhalation Therapy should be made. Bronchial washings - Bronchial washings are obtained at the time of bronchoscopy. - While the bronchoscope is in the bronchus, 5 – 10 mL of saline are introduced into the involved portion of the lung, the material is then aspirated into a U-tube. - The collection tube may be rinsed thoroughly with saline and the rinsing added to the specimen. - Equal parts of CytoLyt fixative may be added immediately if possible. Bronchial brushings - Brushes are obtained at the time of bronchoscopy. - The brush should be smeared on one or two slides, which should be spray-fixed immediately. - The brush may also be clipped and sent to cytology in a jar with CytoLyt fixative. Urine - Voided, catheterized, bladder or ureteral wash specimens are acceptable. - It MUST be specified on the requisition slip if sample is voided, catheterized or a wash specimen, as the processing and interpretation parameters may vary. - To collect a “clean catch” voided specimen: - Males need to wipe clean the glans penis. - Females need to wipe clean between the vaginal labia. - Before collecting the specimen, a small amount should be urinated into the toilet bowl to clear the urethra. - A midstream 40-60 mL sample of urine should be collected in a clean or sterile container. - The first urine of the day is in general inadequate for cytology due to common poor-preservation artifacts. - Equal parts of CytoLyt fixative may be added if possible. - Ideally 3 specimens consecutively collected over a 3-day period should be submitted. Gastrointestinal specimens - Cytologic material may be collected from the esophagus, stomach and intestine at the time of endoscopy. - Brushings and washings are prepared the same as bronchial brushings and washings (see above). Oral scraping - Remove dentures or removable bridges before examination. - Using a tongue depressor, scrape any abnormal appearing area. Spread material obtained on clean slides and spray-fix immediately. Anal-rectal specimens - Sample the entire anal canal (keratinized and nonkeratinized portions) and the anal transformation zone. - Samples are commonly collected without direct visualization of the anal canal, although a small anoscope may be used. - Dacron fiber swabs with plastic handles (preferred) and cytobrushes may be used. - Collect the sample into PreservCyt solution (same ThinPrep vials used for cervical specimens.) Body fluids other than cerebrospinal fluid - Pleural, pericardial, and ascitic fluids may be sent to the cytology department without fixative. - To prevent specimen clotting, 3 units of heparin may be added per mL of fluid. - The sample may be left up to 12 hours without appreciative cellular deterioration. - If longer time is anticipated, the specimen must be refrigerated. Cerebrospinal fluid - The sample is collected at time of spinal tap. - If possible, a separate tube should be collected for cytology. - Cerebrospinal fluids are delicate specimens and should be brought to the laboratory without delay. - If any delay is anticipated the specimen should be refrigerated immediately. Breast secretions - Breast secretion smears are made by: applying a clean glass slide directly to the nipple, smearing the secretion and immediately spray-fixing the smear. - Multiple smears (6-8) may be prepared on every occasion to improve the diagnostic yield. - Alternatively, as much secretion as possible may be aspirated with a syringe, the aspirate then transferred to a jar containing CytoLyt fixative. Skin vesicular lesions - The area may be cleaned with alcohol - The lesions may be opened with a sterile lancet or needle. - Apply a clean glass slide directly to the opened lesion and tap. - Smear and spray-fix immediately. FINE NEEDLE ASPIRATIONS - Only trained physicians may perform fine needle aspirations. - FNA consent form (HCSD 9023 WH) must be completed on all FNAs. - Aspirates are expelled onto the end of clean prelabeled slides and smears are prepared. - Ideally two smears are obtained per pass, one is air-dried and directly stained with Diff-Quik for immediate assessment; the second is spray-fixed or immersed in 95% ethanol for Papanicolaou staining. - The needles are rinsed in CytoLyt solution, which is then used to prepare cell filters and cell blocks. - Alternatively, the entire aspirate may be transferred into CytoLyt solution. - You may request a cytopathologist to perform aspirates of palpable lesions that do not require radiologic guidance. - Pathologists may also be called to assess the adequacy of aspirates performed by other physicians. - The FNA service is available between 08:00h and 16:00h, Monday through Friday, by calling the Cytopathology Laboratory (903-5233, 903-5232) or Dr. Ruiz (568-2004).
Medical Center of Louisiana at New Orleans Revised 08/29/2011