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785-823-7201

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785-823-7185

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338 N. Front St., Salina, KS 67401

Non-Gyn Cytology

WPM Pathology Laboratory   →  Services   →  Pathology   →  Non-Gyn Cytology

GUIDELINES FOR NON-GYN CYTOLOGY

GUIDELINES FOR NON-GYN CYTOLOGY

PRINCIPLE

Examination of cellular material harvested from body fluids is one tool used for early detection of cancer and other pathologic conditions. Because of the difficulty and expense incurred in obtaining these specimens, it is imperative that they are handled with care to preserve cellular detail. The fixative of choice at WPM Pathology Laboratory is CytoRich Red, a polyethylene glycol solution with an autolytic agent, which protects the cells during air drying. (CytoRich Red must not be used for urine.) If unprotected during air drying on the microscope slide, cells will undergo shrinkage beyond that which occurs in alcohol. The shrinkage is caused by the collapse of submicroscopic spaces, in the protoplasm, that are vacated by the evaporating alcohol. CytoRich Red, when used as a fixative, occupies these spaces and prevents their collapse. CytoRich Red is used with all non-gyn cytology specimens except urine, for which Carbowax is required.

SPECIMEN TYPES

  1. Ascitic Fluid
  2. Breast Aspirates
  3. Bronchial Washings and Brushings
  4. Cerebrospinal Fluids
  5. Gastric Washings and Fluids
  6. Other Assorted Aspirates and Fluids Pleural Fluids
  7. Sputum
  8. Urine

SPECIMEN ACCEPTABILITY

In order to maintain specimen integrity and accuracy of reporting, acceptable specimens must meet the following criteria:

  1. A properly and completely filled out WPM test request form must accompany the specimen (see page 13).
  2. The information on the specimen container must match the information on the test request form.
  3. The attending physician must be identified.
  4. The specimen site must be properly designated.
  5. The specimen must be fixed properly.

WPM staff will make every possible effort to obtain necessary information and remediate specimen acceptability issues via telephone. However, to avoid delays it is advised that all clinic/hospital staff involved in the collection and handling of specimens be thoroughly knowledgeable of these policies.

MATERIALS

WPM provides 30 ml vials, which are pre-filled with 10 ml of CytoRich Red fixative. These blue top vials may be used for all non-gyn cytology specimens except urine (see specific instructions for urine). WPM also provides regular carbowax for use with urine specimens. Test request forms and biohazard bags are provided, as well.

STORAGE

Cytology specimens must be fixed immediately after collection. Once properly fixed, specimens will keep for several days and do not require refrigeration.

LABELING OF SPECIMEN CONTAINERS

Specimen containers must be labeled with the following information:

  1. Patient name
  2. Date of specimen collection
  3. Site of collection and type of specimen

SUBMISSION

See pages 44 – 48 for specific specimen instructions.

TURN AROUND TIME

In most cases non-gyn cytology reports will be issued within one to two working days of specimen receipt.

NON-GYN CYTOLOGY RECOMMENDED TECHNIQUE FOR SPECIMEN COLLECTION AND PREPARATION

NON-GYN CYTOLOGY RECOMMENDED TECHNIQUE FOR SPECIMEN COLLECTION AND PREPARATION

GENERAL

WPM Pathology Laboratory utilizes SurePath thin-layer instrumentation and methodology to prepare all non-gyn cytology slides. Utilizing a centrifuge and sedimentation process, SurePath produces a single layer of cells, creating a superior slide preparation. The result is an unobscured view of cellular structures, previously unobtainable through standard slide preparation. WPM requests that all non-gyn cytology specimens (except urine, which is fixed in Carbowax) be fixed, in provided blue top containers, with equal amounts of CytoRich Red fixative, and shipped to WPM Pathology Laboratory in this form. Slide preparation will be done by WPM Pathology Laboratory.

All fluid specimens collected for cytologic examination must be fixed immediately after collection in an equal volume of fixative. WPM Pathology Laboratory provides specific containers (Blue capped 30 ml containers with 10 ml CytoRich Red already included) for this purpose*. A 50/50 mix of body fluid and fixative is optimal, but most mixtures are acceptable as long as the volume of fixative is equal to or greater than the volume of body fluid. Care should be taken to not contaminate the outside of the primary container when adding body fluid. Properly fixed specimens do not need refrigeration.

*NOTE: Urine specimens should NOT be fixed in the blue top containers due to the autolytic agent in the CytoRich Red fixative. Urine specimens should be fixed, in a clean, sealable container, with regular Carbowax.

Specimen container must be properly labeled with patient name, collection date, and type/location of specimen. Care must be taken to insure that the container is securely capped. Container should be placed inside of a secondary container which will contain the specimen should the primary container leak or break in transit to the laboratory. WPM Pathology Laboratory provides biohazard bags for use as a secondary container.

WPM Pathology Laboratory Cytotechnologists and Pathologists are available by telephone during normal working hours for assistance.

ASCITIC FLUID

The fixed specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM along with a properly filled out WPM “SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY” request form requesting: “NON Gyn Cytolog”y, and “Othe”r.

BREAST ASPIRATES

See page 48, “Fine Needle Aspiration”

BRONCHIAL WASHINGS AND BRUSHINGS

The fixed specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory along with a properly filled out WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Lung Washings”.

CEREBROSPINAL FLUIDS

The fixed specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory along with a properly filled out WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Other”.

GASTRIC WASHINGS AND FLUIDS

To insure optimum recovery of the cytologic material, the patient must be properly prepared. The stomach must be free of contamination of food and barium.

Gastric specimens require special treatment to prevent enzymatic destruction of cells. Before intubating the patient, collection bottles should be filled with Carbowax fixative and placed in cracked ice, where they remain throughout the collection procedure.

If acid studies are performed, they should be done first, with the cytologic material being collected afterward. The first aspiration of gastric material is poor for cellular studies. This initial sample often contains mucus, respiratory elements and cells of long standing which have lost their cellular integrity.

After the initial aspiration, the patient is vigorously lavaged. Washings, brushings, and biopsies are then completed.

The fixed specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory, along with a properly filled out WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Other”.

PLEURAL FLUIDS

The fixed specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory, along with a properly filled out WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Other”.

SPUTUM

Sputum specimens should be collected in a clean container. A sputum cup works best for this purpose because of the wide mouth (a urine cup will also work). Specimen should be immediately transferred to the blue top cytology container provided by WPM. Sputa are easier to obtain in the morning, immediately after the patient has risen. Sputum should not be collected after eating. It is advisable to have the patient rinse mouth , before providing specimen, to avoid food contamination.

The fixed specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory, along with a properly filled out WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Sputum”.

NOTE: Handle all sputa as if they are capable of transmitting an infectious disease (i.e. tuberculosis).

URINE

Urine specimens submitted for cytologic study may be collected any time of day after the first morning void. An aliquot of reasonable size is requested from large volume specimens. See page 47 “Specimen Volumes”.

Specimen should be placed in a clean, sealable, container, fixed with an equal, or greater, amount of Carbowax fixative.

NOTE: Urine specimens should not be placed in the blue top cytology containers provided by WPM Pathology Laboratory, as the fixative in these containers includes an autolytic agent.

The fixed specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory, along with a properly filled out WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Urine”.

OTHER ASSORTED ASPIRATES AND FLUIDS

Specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory along with a properly filled out WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Other”.

RECOMMENDED SPECIMEN VOLUMES

Specimen aliquots of reasonable volume are requested. Available specimen volume is dependent upon many variables, but the following guidelines are suggested as target volumes.

Ascitic Fluid: 10 ml, well mixed (50 ml maximum)
Breast Aspirates: whatever is available
Bronchial Washings and Brushings: 10 ml, or whatever is available
Cerebrospinal Fluids: 1 ml, or whatever is available
Gastric Washings and Fluids: up to 3 – 5 ml
Pleural Fluids: 10 ml, well mixed (50 ml maximum)
Sputum: whatever is available
Urine: 60 ml (150 ml maximum)

NOTE: Please submit all clotted material, as well.

FINE NEEDLE ASPIRATION

Fine needle aspiration (FNA) is essentially a type of needle biopsy to sample material from palpable lumps, nodules or tumors using a thin needle (outside diameter 0.6 to 0.9 mm) with negative pressure supplied by an attached syringe. This type of biopsy obtains cellular material for cytologic examination, rather than a segment of tissue. The FNA technique is very different from a cutting needle (14 gauge) biopsy, which obtains a core of tissue for histologic examination.

Because a fine needle can be moved in a back-and-forth motion and in different directions, different parts of the lesion may be sampled. This greatly increases the chances of obtaining cellular material that accurately represents the lesion’s pathology.

The effectiveness of FNA is well documented in medical literature. In order to maximize the effectiveness of this technique, a close working relationship between the pathologist and the clinician is essential. Communication as to the patient’s clinical history and physical findings contributes greatly to the accurate interpretation of the cellular features in the FNA preparations.

PROCEDURE

  1. Label container. (WPM Pathology Laboratory blue top container is preferred. However, if unavailable, a sterile container containing Carbowax may be used.)
  2. As soon as atmospheric pressure is established in syringe, remove needle.
  3. Express the withdrawn fluid from the syringe directly into the labeled container with equal or greater amount of fixative. (Fluid cytology containers supplied by WPM Pathology Laboratory contain 15 ml Cytorich Red fixative.) The syringe may be “washed out” by aspirating and expressing the fluid/fixative solution several times.

Specimen should be tightly capped, properly labeled, and placed in a biohazard bag. Transport to WPM Pathology Laboratory along with a WPM SURGICAL PATHOLOGY AND NON-GYN CYTOLOGY request form requesting: “NON Gyn Cytology”, and “Breast” or “Other”, depending upon specimen site. PLEASE DO NOT SEND NEEDLES TO WPM PATHOLOGY LABORATORY.

NOTE: If blood appears in the syringe, stop the procedure and choose a new aspiration site. Use a new syringe and needle for the new site. Send both samples, in separate containers, to WPM Pathology Laboratory.

COLLECTION GUIDELINES FOR BODY FLUIDS

COLLECTION GUIDELINES FOR BODY FLUIDS

Examination of cellular material harvested from body fluids is one tool for early detection of cancer and other pathologic conditions. Some sites and specimens are easily accessed and lend themselves readily for Cytologic evaluation, thus eliminating other more invasive procedures. Other sites are more difficult to access and more expensive to obtain. Whichever the case, it is imperative that these specimens are handled with care to preserve cellular detail.

The fixatives of choice in this laboratory are Carbowax based fixatives. Carbowax is a polyethylene glycol solution, which protects the cells from air-drying during processing. Carbowax occupies submicroscopic spaces in the protoplasm of a cell and prevents shrinkage and distortion of the cell.

We provide fixative for your NON-GYN/Body fluid specimens.

SPECIMEN TYPES

  1. Ascites Fluids
  2. Breast Aspirations
  3. Bronchial Washing and Brushings
  4. Cerebrospinal Fluids
  5. Gastric Washings and Brushings
  6. Urines
  7. Pleural/Peritoneal Fluids
  8. Thyroid Aspirations
  9. Other assorted aspirates and fluids

LABELING

All body fluids specimens must be properly identified with the following information written on the specimen container (not the lid):

  1. Patient’s first and last name
  2. Source of specimen
  3. Physician
  4. Date of specimen collection

CRITERIA FOR REJECTION

Every effort will be made to resolve problems occurring due to labeling and/or identification. Specimens may be rejected for the following reasons:

  1. No requisition is available
  2. Inadequate identification
    1. Different names on sample, smears(s), container and /or requisition that cannot be clarified by the Physician’s office or hospital.
    2. Attending Physician cannot be identified.
  3. Specimen cite not labeled correctly. (Does not correlate with requisition.)
  4. Specimen not fixed properly
  5. Specimen received from an unauthorized source

MATERIALS AND SUPPLIES NEEDED

  1. Carbowax fixatives are supplied by the Cytology Department
  2. SURGICAL PATHOLOGY & NON-GYN CYTOLOGY request form
  3. Permanent fine tip marker or pencil
  4. Appropriate containers OR 30 ml FNA collection Vials pre-filled with CytoRich Red.

RECOMMENDED COLLECTION TECHNIQUES

All fluid specimens collected for cytologic examination in our laboratory need to be fixed immediately after collection in an equal amount of a Carbowax based fixative, using either the blue fixative for non-bloody fluids or CytoRich Red for Fine Needle Aspirations (FNA) and other bloody fluids.

  1. No minimum specimen volume is required.
  2. Aliquots of a reasonable size of no more than 120 ml are requested from large volume fluids. Please include all clotted material.
  3. An equal amount of fluid and preservative is necessary for proper fixation. With small specimen volumes, more fixative may be used for ease of handling.

The following guidelines further describe the best technique for our laboratory.

  1. ASCITES: Equal amounts of ascites fluid are should be fixed in blue fixative. If a large volume is present, an aliquot of no more than 120 ml may be sent to the cytology department. Please be sure to include all clotted material.
  2. BREAST FLUIDS: All breast aspirates may be suspended in our pre-filled CytoRich Red vials that contain 20 ml of fixative. Aspirations from different sites need to be placed in individual vials and labeled as to specific site. You may request FNA Collection Vials through WPM.
  3. BRONCHIAL WASHINGS AND BRUSHINGS: Add approximately 20 ml of blue fixative to the bronchial wash. You may add this directly to the collection tube. The brush(es) may be dropped into a different container that is filled with blue fixative.
  4. CEREBROSPINAL FLUIDS: For ease of handling, CSF may be added to a larger volume (approx. 10 ml) of blue fixative. A neutral tube works well for CSF fixation and transport.
  5. GASTRIC WASHINGS AND BRUSHINGS: An equal amount of blue fixative is added immediately to gastric washings. Brushes may be dropped into containers filled with blue fixative.
  6. NIPPLE DISCHARGE: Most discharges may be expressed directly into our pre-filled CytoRich Red vials.
  7. PLEURAL AND PERITONEAL FLUIDS: Aliquots of reasonable size may be removed from large volumes of fluid. Mix well and add equal amounts to blue fixative. All clotted material must be submitted, also, in equal amounts of fixative for cellblock preparation.
  8. SPUTUMS: Sputums should be collected in approximately two ounces of blue fixative. A sputum cup works best for this purpose because of the wide mouth. Sputa are easier to obtain in the morning right after the patient has risen. It is advisable to have the patient rinse mouth to avoid food contamination.
  9. THYROID ASPIRATIONS: Thyroid aspiration should be added to our pre-filled CytRich Red vials. Aspirations from different sites need to be placed in individual vials and labeled as to specific site. You may request FNA Collection Vials through WPM.
  10. URINES: Urines may be collected any time of the day after the first morning voiding. Equal amounts of urine and blue fixative are mixed in a 90 ml or 120 ml specimen container.

STORAGE

When properly fixed, all body fluids are stable at room temperature. You do not need to refrigerate a specimen with an equal volume of fixative.

HANDLING AND TRANSPORTATION

All specimens should be placed into a proper, leak-proof primary container with a secure leak-proof lid that is tightly screwed on or fastened. Select the appropriate size of specimen container for the amount of fluid to be submitted. WPM Pathology Laboratory provides a variety of containers for specimen collection.

When multiple specimens are to be examined and diagnosed individually, each specimen must be submitted in a separate, appropriately labeled container.

Place container in a specimen transport biohazard bag.

TURN-AROUND-TIME

Specimens are processed upon receipt, and test results are reported to clients after they are released. Most body fluids may have a report issued within one or two working days after receipt. Specimens requiring special stains, immunohistochemistry, or outside pathology consultation may require more time.