Cytology

1. Pap Smears (LBC)

Special Instructions
Specimen Collection
Patient's Preparation for Cervical Pap Smear Test
Cervical Pap Smear: Collection Technique
Cervex Brush Technique
Combi Brush Technique

2. Non-gynecological Specimens

Smear Preparation
Body Fluids Collection
Cerebrospinal Fluid
Site Specific Instructions
- Special Instructions
- Breast Cyst Aspiration
- Breast Secretions (nipple discharge)
- Bronchial Brushings
- Bronchial Washings
- Cerebrospinal Fluid (CSF)
- Effusions
- Peritoneal, Ascitic and Pleural fluid
- Sputum
- Urine
- Fine Needle Aspiration of any site
- Others (please state site and source)

Procedure

Instructions/ Preparation

Pap smear is a screening technique to aid in the detection of cancer and cancer precursors of the uterine cervix. It is not a diagnostic test. Both false-positive and false-negative results have been experienced. The test should not be used as the sole means to diagnose or exclude malignant and pre-malignant lesions.

Special Instructions

These patient data are essential and must be indicated on the request form:

· Patient’s name and age (or date of birth)

· Date of specimen collection

· Source of smear (cervical os, endocervix, vaginal vault, vaginal pool, lateral vaginal wall)

· Name of requesting doctor

The following pertinent clinical information must be supplied:

· Last menstrual period (LMP)

· Hormonal status (e.g., postmenopausal and pregnancy)

· Exogenous hormone therapy (e.g., birth control pills, treatment for endocrine-responsive malignancy and oestrogen creams)

· Presence of an intrauterine device (IUCD)

· Any abnormal clinical findings or symptoms

· Date of last Pap smear, if any

· History of abnormal cytological or histological findings

· HPV status, if available

Patient’s Preparation for Cervical Pap Smear Test

· Ideal sampling date is 2 weeks after the 1st day of last menstrual period.

· Sampling is discouraged during menstruation and active uterine bleeding.

· Avoid use of vaginal medication, vaginal contraceptives or douches for 48 hours prior to examination.

· If repeat collection is required, it is recommended that this to be done 6-8 weeks later.

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Step 1: Collect

I. Insert the central bristles of the brush (use either Cervex brush or Combi brush) into the endocervical canal. Apply gentle pressure on the cervix until the lateral bristles bend against the ectocervix.

II. Maintain gentle pressure and rotate the brush by rolling the stem between thumb and forefinger.

For Cervex Brush, rotate five times in a clockwise direction.

For Combi brush, rotate two times in a clockwise direction.

Step 2: Drop

Drop the detachable head device into the SurePathTM vial.

Step 3: Send

I. Tighten the cap.

II. Paste the patient’s identification sticker on the vial.

III. Place the vial and patient’s request form into a specimen bag for transport to the laboratory

Non-gynecological Specimens

· Body Fluids e.g., Peritoneal/Ascitic, Pleural, Cerebrospinal Fluid (CSF), Cyst Fluid, Urine, Sputum, Bronchial Washings/Brushings

· Fine Needle Aspirations (FNA) i.e. the removal of a sample of cells, using a fine needle, from a mass/lesion for diagnostic purposes. The mass can be a superficial lump (e.g. in the thyroid, lymph node, salivary gland or breast) or the lesion can be deep-seated and seen radiologically (e.g. lung, liver, pancreas, kidney or retroperitoneum)

Special Instruction

· If more than 1 specimen type is sent from the same patient, use only one request form. Please state clearly the site and source of each specimen in the Computerized Physician Order Entry (CPOE) form.

· Fluid collection in drip bags or large collection bags can be submitted if malignancy is suspected.

· Only Urine and CSF specimens can be send via the pneumatic tube

Smear Preparation

· Use a lead pencil to write the patient’s name on the frosted end of the slide.

· Submit 1-4 smears from each source for cytological evaluation.

· Fix half the number of smears immediately by immersing the slides in 95% alcohol in the slide mailer. Indicate on the slide mailer “wet” for smears that are alcohol-fixed.

· The remaining smears are left to air-dry, and submitted in the slide mailer labelled “air-dried”.

· Refer to illustration on smearing method extracted from ISBN 978-0-323-63636-0.

Body Fluids collection

· Submit fresh fluid (30-1000 ml) to the Cytology laboratory within 1 hour of collection. If delay is anticipated, refrigerate at 4 degrees Celsius.

· Place fluid in a tightly capped and labelled container.

Cerebrospinal fluid (CSF) collection

· Submit fresh specimen (>1 ml) to Cytology immediately. If delay is anticipated, refrigerate at 4 degrees Celsius.

· Place fluid in a tightly capped and labelled container.

Site Specific Instructions

Breast Cyst Aspiration
· If aspirate is scanty, fluid may be drop directly onto clean and dry slides.

· Refer to smear preparation.

· If aspirate is abundant, collect in a clean tube and send it fresh immediately to the Cytology laboratory.

Breast secretions (nipple discharge)

· Discharge/Secretion from the nipple are smeared directly on dry and clean glass slides.

· Refer to smear preparation.

Bronchial Brushings

· Roll brush over clean and dry slide.

· Refer to smear preparation.

· The same brush should then be swished in a fixative provided by the laboratory to dislodge remaining cellular material

· Submit smears and fluid together.

Bronchial Washings

· Collect in a clean tube and send to the Cytology laboratory.

Cerebrospinal Fluid (CSF)

· Collect in a clean tube and send immediately via the pneumatic tube to the Cytology laboratory.

Effusions

· Collect in a clean container and send to the Cytology laboratory.

Peritoneal, Ascitic and Pleural fluid

· Collect in a clean container and send to the Cytology laboratory.

Sputum

· Submit early morning deep-cough specimen prior to the ingestion of any food

· Have the patient rinse mouth with plain water before producing specimen

· Send specimens fresh within 1 hour of collection

Urine

· Avoid the 1st morning specimen and also the initial stream of urine. Collect mid-stream specimen .

· Indicate sample collection method “Voided” or “Catheterised” as appropriate

Fine Needle Aspiration

· Refer to smear preparation for methodology

· Refer to test catalogue for specimen requirement.

· Please indicate pertinent clinical information on the CPOE form including the specific site and source, gross appearance, relevant radiological findings e.g., whether the lesion is solid or cystic and working diagnosis if applicable.

· Upon request by the clinician, cytotechnologist can provide on-site service for preparation of smears as well as evaluation for specimen adequacy.

· For cases suspicious for infectious airborne condition such as Tuberculosis, on-site assistance is not provided.

Cytology Specimen Collection List