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Non Gynae Cytology

 

NON GYNAECOLOGICAL (DIAGNOSTIC) CYTOLOGY

Non-gynaecological examination of body fluids, urine and sputum are provided on-site as a routine service. Fine needle aspiration cytology is available routinely but examination of 'unusual' sites should only be undertaken after discussion with the Consultant Histopathologist.

Handling

All infected specimens should be labelled with 'danger of infection' labels.

The container should be labelled correctly with:

  • patients name
  • unit number
  • date of birth
  • Name and location of requesting clinician

The specimen must be received in the appropriate container or fixative. It should be obtained using the correct procedures and an adequate amount of material sent analysis. The sample must be sent to the laboratory as soon as possible after production. Cell morphology deteriorates with time. (See detailed description of each specimen for requirements for a good sample and type of fixative used).

Request forms

Histology request forms should be used for all cytology investigations. Full details must be entered on to the request form. The remarks made in respect of histology request forms also apply. Clinical details, date and time the sample is taken should also be written on the request forms. If an urgent report is needed this should be stated. The protocol of reporting urgent specimens will be similar to the histology 'urgent' reporting. Specimens and request forms should each be placed in the correct portion of plastic specimen bags.

Copies of the Request form can be found here: Click Here

Reporting of non-gynaecological specimens

Reports on all cytological specimens may be delayed for a further one or two days if special staining methods or immunocytochemical techniques are used to aid in differential diagnosis.

Policy for rejection of specimens

Specimens to be rejected immediately on receipt:

  • Unlabelled specimens.
  • Specimens labelled with patient details different to those on the accompanying request form
  • Specimens received without a request form
  • Specimens received in the wrong fixative
  • Insufficient amount of specimen for the test required.

Specimens to be rejected after preparation:

A report of 'Inadequate' will be issued if after preparation smears show:

Insufficient cells

  • Cells not appropriate to the type of specimen received
  • Cells obscured by extraneous material

Types of Cytological Investigation

  • Respiratory Tract Cytology
  • Sputum
  • Bronchial washings
  • Bronchoalveolar lavage
  • Bronchial brush smears
  • Biliary brush smears
  • Percutaneous lung F.N.A.s
  • Urinary Tract Cytology
  • Voided urine
  • Catheterised urine
  • Serous Effusion Cytology
  • Pleural fluid
  • Peritoneal fluid
  • Peritoneal washing
  • Pericardial fluid
  • Cyst fluid
  • Synovial fluid
  • Fine Needle Aspirate Cytology
  • Lymph node aspirates
  • Salivary gland aspirates
  • Thyroid aspirates
  • Aspirates from any other site
  • Breast Cytology
  • Nipple discharge
  • Cyst fluid
  • Fine needle aspirates
  • C.N.S. Cytology
  • C.S.F.
  • Cytology of the Female Genital Tract
  • Vaginal samples
  • Vault samples

Respiratory Tract Cytology

Sputum

Requirements for a good sample:

  • An early morning specimen before teeth are cleaned or food is taken.
  • A deep cough specimen - Saliva will be reported as 'inadequate'.
  • The specimen should be produced directly into a sterile plastic, screw cap container.
  • Specimens should be produced on 3 consecutive days. Separate specimens should be sent if cytological tests and microbiological tests are required, if possible (this prevents time delays and an unsuitable procedure being applied to the specimen for the test required).

Bronchial Washings and Bronchoalveolar Lavage

Requirements for a good sample:

  • Salinated washings should be sent to the laboratory in the specimen collection pots used in the bronchoscopy procedure.
  • The specimen should be sent as soon as possible.
  • Separate specimens, if possible, should be sent if both cytological tests and microbiological tests are required.
  • If both lungs are sampled, or pre- and post-biopsy specimens taken, forms and specimens must be labelled accordingly.

Bronchial brush smears

Requirements for a good sample:

  • Bronchial brush smears made directly onto glass slides during the bronchoscopy procedure should be placed into smear pots containing alcohol whilst still wet.
  • Slides must be labelled in pencil.
  • Request forms must be completed and slides must be labelled correctly, taking particular care to indicate if both lungs have been sampled.

Percutaneous fine needle aspirates of the lung

Requirements for a good sample:

  • Direct smears should be made from the needle onto clean glass slides labelled with pencil, on the frosted end. These should then be immediately fixed in alcohol whilst still wet.
  • The needle should be washed out into saline or a vial containing Preservcyt solution (this can be obtained from the Histology Department).
  • Any fairly large pieces of tissue obtained may be placed in formal saline.

Urinary Tract Cytology

Voided Urine

Requirements for a good sample:

  • Early morning specimen is NOT suitable as exfoliated cells may have been in the bladder for several hours and will have undergone degeneration.
  • Mid stream specimen is NOT suitable because urothelial cells are passed at the beginning and end of voiding.
  • The whole of the specimen is NOT required. For practical purposes fill 1 sterile universal container (approx. 25ml).
  • Send to the laboratory as soon as possible after production as cells deteriorate very rapidly.

 Catheterised urine

Requirements for a good sample:

  • Catheterised urine specimens can cause interpretational difficulties in cytology and therefore, are less preferable than voided urine.However, if only catheterised urine is available, this should be clearly stated on the form.
  • Fill 1 sterile universal container, i.e., approximately 25ml. Send to the laboratory as soon as possible after production.

Effusion Cytology

Pleural fluid, peritoneal fluid and pericardial fluid

Requirements for good samples:

  • Samples should be sent to the laboratory in sterile universal containers as soon as possible after being aspirated. N.B do not send large containers of fluid 20mls is sufficient for analysis. If a delay is envisaged store in a refrigerator at 4°C.
  • Separate samples with request forms are required by each department if possible, when biochemical or Microbiological tests are required in addition to cytology.

Fine Needle Aspirate Cytology

Lymph nodes, salivary glands, thyroid glands etc.

Requirements for good samples:

  • Routinely FNA samples are washed out into a vial containing Preservcyt solution (this can be obtained from the Histology Department).
  • When direct smears are made onto clean glass slides labelled with pencil:-  If there is only enough material to make one slide this should be allowed to air dry. If there is enough material to make 2 or 4 smears, allow 2 to air dry and  fix 2 in alcohol.

Breast Cytology

Nipple Discharge

Requirements for a good sample:

  • Clean glass slides should be pressed against the nipple. Gentle squeezing may be needed to encourage the discharge.
  • Smears should be labelled in pencil and placed into a smear pot containing alcohol before drying occurs.

 Cyst Aspiration

Requirements for a good sample:

  • Fluid should be expelled into a sterile universal container which should be labelled with the relevant patient details.

 Fine Needle Aspiration

Palpable lumps and non-palpable lumps detected by mammography, (where the lesion is located by stereotactic imaging and aspiration performed under radiological control or under ultrasound guidance).

Requirements for a good smear:

  • Direct smears should be made from the material obtained.  Transfer them immediately to a smear pot containing alcohol before air dying occurs.  The needle is washed out into a labelled universal container containing approximately 10mls of 'cytospin fluid' (obtainable from the Histology department).

Cerebrospinal Fluid

Requirements for a good sample:

  • The whole of the sample obtained should be expelled into a sterile universal container.
  • It should be stated the investigation is for malignant cells
  • Samples need to be sent promptly to the laboratory.