cytology

non-gynae cytology

Non-Gynaecological Cytology

Diagnostic

Diagnostic (Non-gynaecological) cytology specimens should be submitted to the laboratory in a tightly closed container within a sealed plastic bag accompanied by a fully completed green Pathology or ICE generated request form. The type of container used is dependent upon the nature of the specimen (see below). Please state the specimen type clearly on the request form along with any relevant clinical details. It is essential that patient details, including full surname and forename(s), date of birth and at least one of NHS / Hospital Number are included on both the request form and specimen container and that they match in every detail. The date the sample was taken should also be included.

If both Histology and Cytology specimens on the same patient are sent together to the laboratory (e.g. bronchial biopsy and bronchial washings) then each specimen should be placed in a separate plastic bag and two request forms should be completed. If just one request form is completed, please ensure that the specimen details state clearly that the request is for both Histology and Cytology otherwise there may be a delay in reporting.

Separate specimens and request forms are usually required when bacteriological or chemical investigations are needed in addition to cytological examination. However, if the sample is submitted in a single container, please make it clear on the request form that the sample is to be forwarded to Cytology.

Specimens should reach the laboratory by 17.00 otherwise they should be refrigerated and sent the following morning.

Please label high risk specimens clearly and attach a yellow risk sticker to both the request form and sample container. The nature of the hazard should be indicated.

Turnaround Times

As a guide, 80% of samples should be reported within 5 working days and 90% within 10 working days (RCPath standard).

Once a sample is reported it will be available on the Trust result viewer via ICE.

Samples and Collection Details

All samples should be placed in appropriate containers and only small volumes should be sent to the laboratory. Samples should be sent to the laboratory for processing immediately but if late in the day (after 17.00) should be refrigerated and sent first thing the following working day (Monday to Friday). Please avoid taking samples on Friday nights and over the weekend where possible. 

Specific sample requirements are listed (alphabetically by sample type) below:

Bronchial Washings

  • Collect into a plain 30ml universal container.
  • Volume: 5ml – 30ml.
  • Refrigerate if unable to return to the laboratory promptly.

Note: Pneumocystis spp – if this test is required, please alert the laboratory in advance so that a prompt result can be issued. Please clearly mark the request form URGENT – PCP and supply a contact number and ideally phone the laboratory on extension 88723 or 85939 to inform us of the urgent request.

Bronchial Brushings

  • Roll the brush over a microscope slide/s to remove cellular content and fix immediately with spray or dropper bottle fixative. Return to laboratory in a slide carrier and plastic specimen bag.
  • The brush head can be placed into LBC fixative (available from Cellular Pathology Specimen Reception) and returned to the laboratory with the slides.

Cerebrospinal Fluid (CSF)

  • Collect into a plain 30ml universal container.
  • Volume: volumes over 2ml may compromise the patient. Collect as much as possible up to this limit. Typically, samples are adequate at less than 1ml.

Fine Needle Aspirate (FNA)

  • Please use the FNA kit provided by the laboratory – it contains all the equipment required for this procedure except spray fixative, which can be collected separately from Cellular Pathology Specimen Reception.
  • If possible, prepare up to 4 slides by the blood film method.
  • Allow half the slides to air dry and fix the remaining wet slides (with spray fixative solution supplied) immediately the slides are prepared. If in doubt allow all the sides to air dry.
  • Do not fix any air-dried slides.
  • Using a pencil only please write the patient’s name and one of hospital number / NHS number / date of birth on the frosted end of the microscope slides. Also please write AD on any air-dried slides and WF on any wet fixed slides – these are processed differently by the laboratory and incorrect processing may render the slides unreadable.
  • Thoroughly flush the needle & syringe in the needle rinse provided. Please do not return the used syringe and / or needle to the laboratory.
  • Place the slides in the plastic slide carrier.
  • Place the slide carrier and needle rinse in the plastic bag and place this into the carrier box along with the request form.
  • Return the sample to the laboratory as soon as possible – there is no need to refrigerate if the sample cannot be returned to the laboratory the same day it is taken.
  • If you experience any technical problems with slide preparation, please contact the laboratory on x88722 or x85939 to discuss. If we cannot resolve the problem over the phone, we will send a member of technical staff to assist with the procedure.

Gastrointestinal (GI) Brushings

  • Roll the brush over a microscope slide(s) to remove cellular content and fix immediately with spray or dropper bottle fixative. Return to laboratory in a slide carrier and plastic specimen bag.
  • The brush head can be placed into LBC fixative and returned to the laboratory with the slides.

Joint Fluids (Synovial Fluids)

  • Collect into a plain 30ml universal container.
  • Volume: 1ml – 10ml.

Nipple Discharge and Other Small Volume Viscid Samples

  • Prepare a mixture of wet fixed and air-dried slides (refer to FNA sample handling above). Or
  • Collect the sample into a 30ml universal container.

Serous Effusions and Cystic Contents

  • Collect into a 30ml plain (white top) universal container.

    • Volume: Ideally 15ml – 30ml. Please do not send more than 30ml as we do not have the facility to dispose of large volumes.

Sputum

  • Ideally samples should be early morning ‘deep cough’ specimens collected before the patient eats, drinks or cleans their teeth.
  • Please use a plain 60ml collecting container.
  • Volume 20ml – 60ml

Note: There is limited clinical value in sputum samples, but these are sometimes submitted to the laboratory if the patient is unfit for invasive investigation (RCPath guidance).

Pneumocystis spp – if this test is required, please alert the laboratory in advance so that a prompt result can be issued. Please clearly mark the request form URGENT – PCP and supply a contact number and ideally phone the laboratory on extension 88723 or 85939 to inform us of the urgent request.

Urine

  • Samples should be early morning (preferably second micturition of the day) and not mid-stream. The first and last third parts of the stream are optimum for cytology investigations. 
  • Use a 150ml universal container.
  • Do not use a boric acid bottle as this renders the specimen unsuitable.
  • Volume: 100ml – 150ml.

Bronchial Alveolar Lavage Samples for differential white cell counts (BALS)

  • Collect into a plain 30ml universal container.
  • The sample should be sent on ice/ice blocks preferably or cold packs, making sure the request form does not come into contact with the ice.
  • Please arrange transport so that the sample is sent to us as soon as possible after it has been taken due to the cells degenerating very quickly.
  • Please notify us via email when you are sending a sample to us using the following email addresses:
    rwh-tr.cytology-non-gynae@nhs.net
    k.taylor5@nhs.net
    helen.greaves3@nhs.net
  • The Department can only accept and process samples Monday to Friday 9 am-5pm and the Department is closed on bank holidays.

Consumables

Specimen request forms, sample containers, sample bags, transport media, LBC vials and FNA consumables are supplied by the Cytology laboratory and can be requested by emailing the NG email address:

rwh-tr.cytology-non-gynae@nhs.net or calling 01902 307999 ext.88722/88723.