Details of the specific fixation required for each of the specimens taken are given in the specimen collection section below.
Please ensure that the specimen is placed on the labelled side of the slide. Fluid specimens must be spread thinly (blood film technique).
Slide preparations requiring fixation are sprayed with Cytofix or immediately immersed in Industrial Methylated Spirit to prevent the specimen drying before fixation. Formalin should not be used as a cytology fixative. Slide preparations requiring air-drying should be dried as quickly as possible by agitating in air (any form of heating should not be used in this process). Both request form and slide preparation must state whether the preparation is fixed or air-dried. Absence of this information may lead to inappropriate processing rendering the specimen unsuitable for cytological assessment.
If Lymphoma is suspected and flow cytometry requested please send sample directly to Immunology Level 6 (int 52390). Do not send to Cytology as samples must be received for analysis as fresh as possible.
Bronchial Tract Specimens: Bronchial tract specimens include bronchial lavage samples and bronchial brushings. Bronchial lavage samples are suspended in saline. Please collect lavage sample in a 50 ml, sterile, container containing at least 30mls PreservCyt. Brush specimens may be spread directly onto a slide and/or the head of the brush may be detached and placed in PreservCyt collection fluid for transportation. Agitate brush in PreservCyt, then remove brush before sending to Cytology. Direct preparations must be fixed to reduce the risk of infections associated with this specimen type.
Cerebrospinal fluid (CSF): When sending CSF specimens for cytological examination (i.e. not microbiological/biochemical testing) to the Cellular Pathology Laboratory (ext, 52355) during normal working hours, please ensure that the sample is taken directly to the laboratory so that it is received before 4pm. 3-5 ml of CSF should be placed in a labelled, 25 ml tall, sterile, white capped universal container. No fixative should be added and the accompanying request form must be red spotted. If the sample is being sent to exclude malignancy, please send a minimum of 5ml and take the sample in the first part of the week (Monday – Wednesday), so that additional tests can be applied to the sample if necessary prior to the weekend.
If the sample needs to be taken out-of-hours (after 5.30pm or on weekends) as part of other urgent investigations e.g. for meningitis, the sample should be refrigerated overnight and delivered to the laboratory between 9 and 10am on the next day (including Saturday and Sunday). The on-call BMS should be informed (contact via the switchboard) if the sample is taken out-of-hours.
EBUS: EBUS samples are to be submitted in formalin and that they should not be refrigerated before delivery to the laboratory
Fine Needle Aspirations and Breast Cyst Aspirates: Fine needle aspiration is performed on palpable and impalpable lesions. The most common sites for palpable lesions are breast, thyroid, soft tissues and lymph nodes. Impalpable lesions need to be identified by some form of imaging device. Cytological specimens will preferably be presented as direct smears (2 air dried preparations) as well as cell suspensions from needle washings in PreservCyt, which is available from the Cytology Laboratory. Any FNA samples suspecting Lymphoma should have a second pass into Saline for Flow Cytometry (cells are unstable in this solution so samples should be hand delivered to Immunology on Level 6).Breast cyst aspirates may be sent as fluid and/or direct (air dried) smears. Please use 25 ml tall, sterile, white capped universal container.
Gastrointestinal Tract Specimens: Specimens from the gastrointestinal tract include indirect scrapes from oral lesions, as well as oesophageal and gastric brush samples and washings. Brush specimens may be spread directly onto a slide and/or the head of the brush may be detached and placed in PreservCyt for transportation. Agitate brush in PreservCyt then remove before sending to Cytology. Please ensure that direct smears taken for the investigation of candida infection are fixed as air dried preparations are unsuitable for this type of test.
Nipple Discharge: Nipple discharge is routinely received as two direct air-dried smears.
Serous Fluids (Pleural fluid, peritoneal fluid, pericardial fluid, ovarian cyst fluid): Serous fluids may be received as the result of direct taps/aspirations of effusions from pleural, peritoneal and pericardial cavities. The optimum amount is 75-100 mls, less than that may compromise cell content but, on the other hand, large volumes of fluid may not improve the cell yield and create unnecessary preparation problems in the laboratory. Serous fluid samples should be dispatched without delay to the laboratory for processing. Peritoneal washings and ovarian cyst aspirates may also be sent for cytological investigation. Please use 50 ml, sterile, or universal container.
Sputum Specimens: Sputum samples are of limited value in the diagnosis of lung cancer. Correct collection is essential to ensure the sample originates from the lower respiratory tract. It is advisable not to send sputum samples prior to referral of the patient to a respiratory physician as cytology and biopsy specimens collected at flexible bronchoscopy have greater diagnostic sensitivity. Sputum samples should be collected on three consecutive days. Early morning expectorate is preferred, to eliminate contamination. The sputum should be from a deep cough, not a salivary ‘spit’. Please use wide necked container adding at least 30 mls PreservCyt.
Synovial fluids: Synovial fluid samples for the examination of crystals are not tested in the Cytology laboratory – please send to Microbiology. Only samples suspicious of cellular abnormalities are to be sent for cytological investigation. Please use 25ml tall, sterile, white capped universal container.
Urinary Tract Specimens: Urine samples should be collected on three consecutive days. It should not be the first morning sample nor a 24-hour collection since cells deteriorate quickly in urine. The first 20ml should be collected for cytological investigation. Urine samples should be dispatched without delay to the laboratory for processing. Please use 25 ml tall, sterile, white capped universal container.
Please return any formalin or cytospin collection fluid which is past the expiry date to the laboratory for disposal.
Cervical cytology kit supplies
The Severn Pathology Laboratory (Bristol) has gone into partnership with a company called Cellpath to provide all of the consumables for cervical screening, this includes vials, brushes and transport bags.
You will receive regular automatic scheduled deliveries based on your average usage.
Each surgery has received an email from CellPath with your annual schedule which will have a unique CellPath order reference number.
If you need to delay or bring forward your delivery, you can contact CellPath; email – email@example.com or call 01686 611333 and quote your reference number.
For more information please visit: www.severnpathology.com
or any further questions please contact: 0117 414 9889 or email firstname.lastname@example.org