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Non-Gynecologic Cytology

ThinPrep Non-gynecologic Sample Collection

Collection
Samples to be processed on the ThinPrep processor should arrive in the lab either fresh or in CytoLyt solution. There are preferred collection methods for different sample types. This section will describe the Cytyc-recommended procedure as well as alternate collection methods.

Mucoid specimens
Mucoid specimens, sputa and brushes, are best collected into CytoLyt solution. If they are collected fresh, CytoLyt solution should be added as soon as possible. Early addition of CytoLyt solution preserves the sample and initiates the mucus dissolution process.

For washes and lavages, do not expose the patient to CytoLyt solution. These samples must be collected in a balanced electrolyte solution. Large-volume mucoid specimens (greater than 20 ml) should be concentrated before addition of CytoLyt solution to the sample.

Fluid specimens
The preferred method for preparing fluid samples (urinary tract, effusions, synovial and cyst fluids) is to concentrate the fresh sample before any addition of CytoLyt solution. If this is not possible and the samples must be preserved for transport to the lab, collect the samples in CytoLyt solution.

Anal-rectal specimens
Proper anal cytology screening involves sampling from the anal verge, past the dentate line, into the rectal vault. It is important to sample the area of squamous metaplasia that is analogous to the transformation zone of the cervix.

Sampling is performed by insertion of a cytobrush or moistened Dacron swab five to six centimeters into the anal canal and applying pressure to the sampling device as it is rotated circumferentially around the anal wall. The sampling device is then vigorously swirled in liquid preservative media. Liquid-based cytology is the preferred method due to increased cellular yield, improved preservation, elimination of air-drying artifact and reduction in fecal, bacterial or inflammatory debris that may obscure cellular detail. If liquid-based cytology is not available, a conventional smear can be prepared and immediately fixed in 95 percent alcohol or with a fixative spray. The liquid base vial or slide is submitted to the laboratory with a completed cytology requisition.

 

Fine needle aspirate specimens
Any palpable lesion may be aspirated using a fine needle and syringe. This technique is especially useful for breast, thyroid and cyst aspirations. The patient should be made comfortable using a local anesthetic for outpatient procedures. The skill and training of the clinician will directly influence the clinical usefulness of the specimen obtained. It may be necessary to move the needle in and out of the lesion to obtain the best specimen or trap cellular material from solid lesions within the bore of the needle. The technique described later in this section should be used to transfer material from the syringe into the PreservCyt solution. The container should be labeled with the patient’s name, type of specimen and submitting physician’s name. A cytology requisition is filled out per CPA Lab’s instructions. The specimen and requisition should be placed in a double-walled plastic bag with the requisition in the back flap; separated from the specimen to prevent contamination in the event of leakage. The bag should then be placed in the appropriate area for courier pickup.

Fluids for Cytology Collection Instructions

  1. Fluids from cyst aspirations, urine, sputum and bronchial washings should be placed in an equal amount of cytology fixative, such as CytoLyt or 50 percent alcohol.
  2. Label the specimen jar with the patient’s complete name as it appears on the specimen requisition.
  3. The cytology requisition should be completed with complete patient name, date of birth, Social Security number, complete address, specimen site, clinical impressions and ICD-9 code. A copy of the patient’s insurance card should be attached to the requisition.
  4. Any slides made from nipple discharges or other body fluids should be immediately sprayed with cytology fixative.
  5. Call CPA Lab at (502) 736-4371 for specimen pickup.

 

Fine Needle Aspiration
Collection Instructions

  1. After the aspiration procedure is completed, aspirate 2cc of CytoLyt fluid into a syringe.
  2. Remove the needle from the syringe, introduce several cc’s of air into the syringe (vertically held), reattach the needle and force fluid containing total syringe and needle contents into CytoLyt container.
  3. Procedure may be repeated to ensure total emptying of needle bore contents and any flecks of tissue visible on interior syringe surface. More fluid may be aspirated if necessary.
  4. Label the CytoLyt container with the patient’s full name and complete the cytology requisition with the patient’s full name, date of birth, Social Security number, complete address, site of aspiration and any pertinent patient information, including the ICD-9 code for patient visit. A copy of the patient’s insurance card should be attached to the requisition.
  5. Call CPA Lab at (502) 736-4371 for specimen pickup.
  6. Results will be forthcoming in 24 hours for routine cases. RUSH cases should be marked as such on the requisition and the laboratory notified so that immediate interpretation and communication with the clinician can be facilitated.

 

Body Fluids for Cytologic Examination

Urine
A catheterized specimen of urine is preferred. However, voided urine often is of diagnostic value, particularly from male patients. For cytologic evaluation of the bladder, three morning samples of urine, each of about 50 to 100 ml, obtained on consecutive days are recommended. Aliquots of the voided urine should be immediately placed in CytoLyt. Urine should be voided into sterile containers and a representative aliquot of approximately 20 cc transferred to the CytoLyt container.

Sputum
Cellular material from the respiratory tract may be either the result of a spontaneous expectoration or may be obtained artificially. Sputum is the result of a spontaneous “deep” cough bringing up material from the small bronchi and the alveoli. The cough reflex may be simulated artificially by means of inhalation of cough-stimulating substances. Morning specimens resulting from overnight accumulation of secreta yield the best diagnostic results. Three specimens on three successive days should be collected to ensure diagnostic accuracy. Spontaneous expectorations must be collected in CytoLyt immediately or placed in sterile containers and transferred to CytoLyt containers as soon as possible to prevent cellular degradation and drying artifact. The patient must be carefully instructed not to spit into the fixative without a deep cough as saliva is of no diagnostic use.

Nipple Discharge Collection Instructions

Due to the small amount of fluid available from nipple discharges, these samples should be submitted on glass slides. The fluid should be expressed from the nipple onto a glass slide and the fluid smeared using a cover slipping technique. The slide should be immediately sprayed with cytology fixative and labeled with the patient’s name in pencil on the frosted area of the slide.

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