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Cytology Specimens

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									Cytology Specimens

Specimens should be sent to Cytology immediately. If specimen cannot be sent
immediately, refrigerate. DO NOT FREEZE. Fill out a cytology requisition form
for each specimen submitted. Include the following information:

   First and last name of the patient.
   Medical Center identification number or unique identifier.
   Patient location.
   Ordering physician.
   Name or initials of person collecting the specimen.
   Date and time of collection.
   Pertinent clinical data including clinical history.

Each specimen container must be labeled with the following information.

   First and last name of the patient.
   Medical Center identification number or unique identifier.
   Patient location.
   Ordering physician.


Gynecological Smears

Many different techniques exist for obtaining gynecological material for pap
smears. These include aspiration of vaginal pool, cervical scrapes, endocervical
aspiration, and mixed smear of vaginal and cervical origin. All of these methods
are effective and the laboratory cannot dictate which method must be used. We
will accept any specimen provided the material is adequate in the amount and is
properly preserved. We provide the following as a guide for the novice.

Standard Pap Smear

   The patient should not douche or use vaginal medication for 24 hours prior to
    obtaining the specimen.
   The patient’s name should be written in black lead pencil on the frosted end
    of the slide, same side that specimen is applied.
   Insert speculum without use of lubricating jelly and collect the specimen.
   Note: Any other lubrication may make the obtained material unusable.
   Using shaped spatulas and endocervical brush, sample the entire
    ecto/endocervical surface. A variety of collection devices are now available to
    facilitate adequate endocervical sampling. Spatulas are adequate for the
    vaginal, ectocervical and endocervical specimens.
   Quickly smear the obtained material over the entire glass surface. Without
    allowing the slide to air dry, immediately spray the slide with cytology fixative.
SurePath Pap Smear (liquid-based Pap)

   Using a Rovers Cervix-brush , insert the central bristles into the
    endocervical canal.
   Maintaining gentle pressure, rotate the brush clockwise five times.
   Insert the brush into the sure path vial. Detach the handle of the brush.
    Reseal the vial
   Label the vial completely for patient identification.

Maturation Index Collection

   Label slide with a black lead pencil with patient’s first and last name.
   Insert speculum without use of lubrication jellies and take smear from the
    Lateral vaginal wall.
   Smear uniformly on slides and fix immediately with cytology spray fixative.

Body Cavity Fluids

   Examples: spinal, pleural, ascitic and cystic fluids.
   Portions of fluid that are clotting should be submitted anticoagulated
    (heparinized).
   A maximum sample of 200cc is needed.
   The fluid is transported to the lab in any suitable, clearly labeled container.
    Specimens should be refrigerated until sent to the lab.

Breast Specimen Collection

        Nipple Discharge:

        The first few drops of discharge should be wiped away because they will
         contain mainly degenerated cellular debris.
        Using a pre-labeled slide, draw the glass slide across the nipple to
         produce a uniform smear.
        Fix immediately with spray fixative.
        Continue to make slides until the secretion stops.

    Cyst Fluid Aspiration:

        Draw the cyst fluid into a syringe and submit to the lab, properly labeled
         with patient’s name.
        Specimen should be refrigerated until it is sent to the lab.

    Solid Mass Aspiration:

        Aspirate specimen into a syringe.
        Properly label with patient’s name.
        Submit to the lab or refrigerate until specimen can be sent to the lab.
Bronchial Brush and Wash Collections

    Bronchial Washing:

   Specimen should be sent in a clean, tightly sealed tube or container.
   Clearly label the specimen and refrigerate until able to send to the lab.

    Bronchial Brushing:

    Bronchial brushings can be handled in one of two ways:
    1. Place the entire brush in a screw top test tube containing saline and
       submit to laboratory as soon as possible.
    2. Smear the brush material directly onto a pre-labeled (use pencil) glass
       slide. Spread all of the brush material uniformly over the slide.
       Immediately spray cytology fixative.

Sputum

   A deep cough specimen is the only acceptable one. Saliva, post-nasal
    discharge and food-contaminated materials are not acceptable.
   Instruct the patient to obtain the specimen the first thing in the morning. Have
    the patient rinse his/her mouth with water and discard the material. Next
    have the patient breathe deeply as possible and exhale with an expulsive
    cough into a sample cup.
   If the patient cannot bring up any material from his lungs, contact respiratory
    therapy about sputum induction.
   The specimen must be quickly transported to the lab in a clearly labeled
    container. If there is a delay, refrigerate specimen or put specimen into a cup
    containing Mucolexx to avoid specimen cellular degeneration.

Thyroid Aspiration Collection

   For a small amount of fluid (1-2cc) smears can be made by expressing a drop
    of specimen onto a glass slide. Using a second slide, place on top of the first
    slide (frosted sides together) and pull apart to make a uniform smear. Fix
    smears immediately with spray fixative.
   For Wright stained slides: repeat the smearing procedure for 1 or 2 slides and
    let air dry. Please indicate which smears is air dried on the slides.
   For larger amounts of fluid expressed, send fluid in a capped syringe for
    processing. Refrigerate the specimen if there is any delay in submitting to the
    lab.

Tzank Smear Collection (for Herpes)

   The lesion to be sampled can be broken with a sterile blade or an inoculating
    needle.
   Scrape the base of the lesion with a tongue depressor, cervical spatula or
    sterile blade. If fluid is present it can be captured with an inoculating needle.
   Immediately smear the specimen onto a glass microscope slide labeled with
    the patients name (use pencil).
   Spray the slide immediately with cytology spray fixative, if the slide is not
    sprayed immediately, the specimen will air-dry and a diagnosis cannot be
    rendered.
   Place slides in a plastic Pap smear container. Transport the specimen to the
    lab.


Urine

   Specimens other than the first morning void are preferred.
   Minimal sample size is 5cc; 50 to 100cc are preferred.
   Catheterized or voided specimens should be transported in a clean clearly
    labeled container.
   All specimens must be quickly transported to the lab to prevent cellular
    degeneration or refrigerated until it is sent to the lab. 24-hour specimens are
    unacceptable.
   The specimen must be quickly transported to the lab in a clearly labeled
    container. If there is a delay, refrigerate specimen or put specimen into a cup
    containing Mucolexx to avoid specimen cellular degeneration.

								
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