Cytopathology: Clinical Services - Submit a non-gynecologic sample

Sputum

A sputum series for cytology consists of a fresh, early morning specimen each day for three days. DO NOT SUBMIT 24-HOUR SPECIMENS

When sputum studies are requested for both cytology and microbiology, two separate specimens must be obtained, each accompanied by the proper request slip.

Recommended procedures are as follows:

1. Give the patient a clean sputum cup which contains 15-20 ml of sputum fixative. (The fixative can be obtained in the Cytology Department, 916-734-3031). Instruct the patient not to use it until morning.

2. Have the patient rinse the mouth with water to remove food debris.

3. Have the patient expectorate by a deep cough from the diaphragm and collect the material into the cup containing fixative.

4. The cup should be delivered to SARC, 2P340. The sputum fixative is a preservative and the specimen may be delivered at the patient's convenience.

Bronchoscopic Material (bronchial brush, wash and broncho-alveolar lavage fluid):

Bronchial brush tip must be submitted in 5-10 ml cytology fixative. (The fixative can be obtained in the Cytology Department, 916-734-3031). Please leave no more than 1-2 inches of wire attached to brush tip.

Submit a separate slip for each specimen. If studies are requested for both cytology and microbiology, two separate specimens must be obtained, each accompanied by the proper request slip.

Pleural and Abdominal Fluids:

Send entire fluid specimen collected immediately following the tap to SARC, 2P340. Do not add fixative. Do not decant specimens. Do not discard any portion of the specimen.

Urine:

For Tumor Cells: The best specimen of urine for tumor cell detection is a morning specimen. The best sample is 2^nd or 3^rd voiding of the day. Do not collect the first voiding of the day.

For Cytomegalic Inclusion Bodies: Urine specimen should be collected in a cooled container suspended in ICE and delivered immediately to SARC, 2P340.

Esophageal and Endoscopic Brush and Wash Samples:

Submit brush in 5-10 ml cytology fixative, saline or Saccomanno fixative. (The fixative can be obtained in the Cytology Department, 916-734-3031. After hours the fixative is available in SARC, 2P340. Submit a separate slip for each sample. Spray fix any smears made from the brush tip immediately with Spray-Fix. If studies are requested for both cytology and microbiology, two separate specimens must be obtained, each accompanied by the proper request slip.

Breast Secretions, Skin Scrappings, Oral Scrappings (Tzank smears), Eye (conjunctival) Scrappings:

Obtain sample by scraping lesion deeply with tongue depressor or end of Ayers Cervical Spatula. Do not use cotton swab to collect material as cellular material is trapped in the fibers and will not adequately transfer to the glass slide. Spread sample on labeled slides, fixed immediately with Spray-Fix and deliver to SARC, 2P340.

Miscellaneous Fluids:

Bile from T-tubes, spinal fluids, etc., are sent unfixed to SARC, 2P340.

Gastric Cytology:

Specimens for gastric cytology must be obtained according to the following procedures.

Anal Cytology:

• Anal cytology is for the screening of males/females with high-risk history for anal squamous intraepithelial lesion (ASIL).
• Glass microscope slides may be prepared and spray-fixed. Preferably, specimen should be collected in Non-GYN ThinPrep^® cytology fixative and transported to the laboratory within 24 hours of collection, with appropriate clinical history.
• The presence of lubricant on sample may be considered unsatisfactory for interpretation.
• Expired ThinPrep^® Preservative solution, leaked containers, unlabeled or mislabeled vials will be rejected and require recollection.

• Collection Materials:
  • Hologic ThinPrep^® 20 mL Non-Gyn PreservCyt pre-filled vial. 
  • Non-absorbent Dacron swab (only).
• Collection Method:
  • Moisten a Dacron swab with sterile water, not lubricant. Do not use a cotton swab. Cells adhere to cotton and are not readily released into the fixative media.
  • Insert swab approximately 1.5 – 2.0 inches into the anal canal.
  • Remove swab while applying mild to moderate pressure to the wall of the anus while rotating in a spiral motion sampling the transition zone. 
  • Thoroughly swish and swirl the head of the collection swab in the fixative solution.  Alternatively prepare slides by spreading the material are immediately spray fixing with alcohol cytologic fixative.
  • Cap theNon-GYN ThinPrep^® preservcyt vial securely until a “click” is heard and label with the patient’s name, medical record number and date of collection.

NOTE SPECIMENS MUST BE RECEIVED ON ICE. Obtain eight 50 ml centrifuge tubes from the Cytology Laboratory and stand them in a pan of ice.

• Preparation of the Patient: Ordinarily, all that is required to prepare the patient is an overnight fast. If, because of retention, the possibility of contamination by food or barium is present, the stomach should be cleansed prior to the fast by aspiration with an Ewald tube and washing the esophagus with Ringer's solution.
• Tube insertion: An 18 French rubber Levin tube is passed through the mouth.
• Collection of Material
  • Esophagus: With the tip of the Levin tube at the cardia, the patient is given approximately 100 ml of Ringer's solution to swallow slowly. As the fluid is swallowed, gentle aspiration with a 100 ml syringe is performed. The material thus obtained represents a sampling of the entire esophagus. Following the esophageal swallow, the tube is withdrawn 3-5 cm and the area at this point is washed with 20-40 ml of Ringer's solution. This procedure is repeated at graduated levels until the upper esophagus is reached. A fluid return of approximately one-half the amount injected is to be expected. In the presence of an obstruction, however, the aspirate will approximate the amount instilled.
  • Stomach: The stomach is aspirated and the contents placed in centrifuge tubes and labeled "residual contents". With the patient in the sitting position, 200 ml of Ringer's solution is injected vigorously into the stomach with a 100 ml syringe and then aspirated into the syringe, with this maneuver being performed repeatedly over a 3-minute period. The forceful movement of the solution tends to remove the protective mucus enhancing the exfoliation of cells. The fluid is then aspirated and immediately placed in the centrifuge tubes immersed in ice. Label tubes "first aspirate". Another 200 ml of Ringer's solution is injected into the stomach and the patient then is rotated on the left and right sides for two minutes each while the vigorous introduction and withdrawal of the fluids are continued. The fluid is aspirated and placed in centrifuge tubes IN ICE. Label tubes "second aspirate". The entire collection is taken immediately to SARC, 2P340.