Test Repertoire (Cytology)
All unfixed Cytology cell samples will begin to degenerate from the moment of collection, thereby rendering them difficult to interpret and potentially unsuitable for diagnostic purposes. In the interests of the patient, it is advisable that they be transported to the laboratory for processing as soon as is possible to minimise autolysis and promote accurate and timely reporting.To facillitate this, specimens must arrive in the laboratory correctly labelled and packaged and accompanied by an appropriate request form completed with the minimum data set and all relevant patient and clinical details.
Early morning deep cough specimens resulting from overnight accumulation of secretions yield the best diagnostic results. A single specimen taken on each of three consecutive days should be sent to the laboratory for analysis as soon as it is collected to maximise diagnostic accuracy. The patient must be carefully instructed not to spit without a deep cough as saliva is of no diagnostic value. The specimen sent is randomly sampled and 5-10ml is regarded as the minimal optimal volume requirement for this test.
Examples of these include, pleural or ascitic effusions, peritoneal washings, breast cyst fluid, hydrocele fluid and ovarian cyst fluid. These should be sent fresh, directly to the laboratory or kept refrigerated until transported. A maximum of 25 mls of the sample should be delivered to the laboratory in a sterile universal container for processing. Do not send drainage bags as transport and disposal of large quantities of unfixed fluid present health and safety risks.
URINARY TRACT CYTOLOGY
A freshly voided or catheter sample should be collected into 250ml urine pots and sent directly to the department. If this is impossible refrigerate and transport at the first available opportunity. The second full voided specimen of the day is optimal for accurate cytological assessment. Avoid sending the first specimen of the day i.e. an early morning urine, as this has the disadvantage of marked cellular degeneration. Urine bottles are available from the Cytology department. Please indicate if it is a catheter sample.
Examples of these include , gastric, rectal, oesophageal, and bronchial brushings.
Using clean slides, clearly label the frosted end in pencil, with patient name and PID as a minimum. Spread sample by rolling the brush along the slide. Preparations must be fixed immediately with an alcohol based fixative to preserve the material. Immediate fixation is essential to promote and enhance staining and subsequent accuracy of reporting.
Please write on the slide if the samplemslide is air-dried or fixed as this helps to ensure the correct sample preparation is performed
Brushes used for brush washing liquid based cytology preparation must be thoroughly rinsed in 10 ml of CytoLyt as soon after collection as possible. Any delay in this process may compromise both the quality and quantity of diagnostic material shed from the sampler into the vial and result in potentially suboptimal preparations upon which the diagnosis may be based.
Place slides in a slide carrier (ensure they are separated) for transportation
FINE NEEDLE ASPIRATION CYTOLOGY (FNAC)
Examples of these include aspirates from, breast, lymph node, thyroid, and salivary gland .;
Slides prepared in the clinic for FNAC may either be air-dried and/or alcohol fixed and will be stained in the laboratory accordingly.
It is imperative that specimens are spread thin and evenly and are either wet fixed and or dry fixed immediately, to promote optimal fixation, staining and therefore accuracy of reporting.
Direct Slide Preparation Technique:
These specimens are particularly delicate and require immediate preparation to prevent cellular degeneration. They must be sent directly to the laboratory in a sterile universal container clearly labelled with the patient's name and PID. If sending after 16:00 please inform the laboratory at the earliest opportunity prior to despatch to ensure staff availability for timely preparation. Sample volume obtained from the patient for this test is usually less than 1ml hence all material sent is usually processed.
BRONCHOALVEOLAR LAVAGE CYTOLOGY (BAL)
(for differential cell count)
BAL specimens must be in as near a natural state as possible for accuracy of reporting. They must be collected into a sterile, labelled universal container and packed on crushed ice and transported immediately to the laboratory for preparation to prevent cellular degeneration. Sample volume obtained from the patient for this test is variable however 30 ml is the expected average.
BAL samples for differential cell count must be sent to the laboratory packed in crushed ice, sealed and delivered to Pathology by a porter immediately after sample collection. - this is essential to ensure minimal cell degeneration.
Please notify the laboratory prior to BAL sample collection to inform them of approximate time of arrival. For optimal results BAL samples should be collected and received at the laboratory for processing on the same day. This ensures that the slide preparation can be completed as soon as possible to minimise the risk of cellular degeneration on the differential cell count results.
Collection of BAL samples during the early part of the working day is encouraged to permit transport time to the laboratory and time for processing and preparation of the slides the same day of sample collection.
If the sample is expected to arrive after 16:00 pm the department must be notified with an approximate time of arrival to ensure that there is staff availability.
Please be advised that the laboratory opening hours are 8:30 – 17:30. In the event that a BAL sample is collected and sent to the laboratory outside of these hours the sample will be refrigerated until the laboratory next re-opens. There is a risk that during this time degeneration of cells can occur which can have an impact on results.
SYNOVIAL FLUID CYTOLOGY (for crystals)
These specimens must be sent in a sterile white capped universal container. Please ensure the request form is clearly labelled "for crystals". 5ml is an optimal sample volume for processing and reporting.
Miscellaneous Non-Gynae Samples
Please contact the Cytology laboratory for advice regarding unususal samples.
Factors affecting performance
Please ensure that samples arrive in the laboratory as soon as possible after collection as unfixed cells degenerate quickly
Please ensure that unfixed material spread onto glass slides following FNA procedures are air dried rapidly to facillitate staining
Please ensure that cytology brush specimens spread on glass slides are fixed immediately with spray fixative to prevent cellular autolysis
Please ensure that material left over from cytology brush samples are immersed in fixative solution (PreservCyt) immediately following procedures.
Please inform the laboratory of any urgent samples to facillitate reporting times
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