CYTOLOGY

Specimen Collection and Handling

I. Gynecological Specimens

A.   Conventional Pap Smears
1.       Write the patient’s name on the frosted end of the slide(s) in pencil.
2.       Prepare 1-2 slide(s) and spray fix immediately.
3.       Once the slides are dry, place into the slide holder.
4.       Completely fill out the pathology request.
5.       Place the specimen and the request in a biohazard bag.
6.       Submit to the Cytology Department.

B.  ThinPrep Pap Smears
1.       Obtain an adequate sampling from the cervix and endocervix.
          a. For broom-like device, rotate the broom in a clockwise direction 5 times.
          b. For the endocervical brush device, insert the brush into the cervix until the bottom most fibers 
              are exposed.  Slowly rotate ¼ to ½ turn in one direction.  DO NOT OVER ROTATE.
2.       Rinse the devise as quickly as possible in the PreservCyt Solution by rotating the device in the solution
          at least 10 times while pushing against the PreservCyt vial wall.
3.       Tighten the cap so that the torch line on the cap passes the torch line on the vial.
4.       Label the vial with the patient’s name.
5.       Place the specimen and the request in a biohazard bag.
6.       Submit to the Cytology Department.

C.  Maturation Index Samples (MI)
1.       Label the frosted end of the slide with the patient’s name (in pencil).
2.       Collect the specimen from the lateral vaginal wall.
3.       Smear the material evenly onto a clean glass slide.
4.       Spray fix immediately.
5.       Once the slides are dry, place into the slide holder.
6.       Completely fill out the pathology request.
7.       Place the specimen and the request in a biohazard bag.
8.       Submit to the Cytology Department.

II.    Non-Gynecological Specimens

A.      Body Fluids
1.       Add the body fluid to Cytolyt Solution (3 parts specimen to 1 part Cytolyt).
2.       Label the container with the patient’s name.
3.       Completely fill out the pathology request.
4.       Place the specimen and the request in a biohazard bag.
5.       Submit to the Cytology Department.

B.       Smears
1.       Label a clean glass slide with the patient’s name.
2.       Evenly smear the material onto a clean glass slide.
3.       Spray fix immediately or drop the slide into 95% alcohol container.
4.       Completely fill out the pathology request.
5.       Place the specimen and the request in a biohazard bag.
6.       Submit to the Cytology Department.

C.      Fine Needle Aspirates (FNA)

            Label all slides and containers used in collection of the patient’s specimen at the time of the procedure with the patient’s name.

      Place a drop of the specimen on a clean glass slide.

      Gently place an inverted glass slide on top of the first slide and lightly pull the two slides apart.  Smears should be made as thin as possible.

      Immediately fix (spray with cytology fixative or drop into 95% alcohol) one slide and allow the other one to air-dry.  Or both slides can be fixed.

      Place an “X” on the fixed smear on the frosted end of the slide.

      If tissue fragments or clots are present on the slides, gently scrape these off with a needle and place in 10% formalin.

      Remaining clot or fluid in the syringe should be placed in cytology fixative.

      Submit specimen with completed requisition form.

a.  Thyroid FNA
1.       1-2 air-dried smears
2.       1-2 fixed smears
3.       cyst fluid placed in cytology fixative
4.       needle/syringe rinsed in cytology fixative

b.  Lymph Node FNA
1.       1-2 air-dried smears
2.       1-2 fixed smears
3.       needle/syringe rinsed in cytology fixative

c. Breast FNA
1.       1-2 fixed smears
2.       cyst fluid placed into cytology fixative
3.       needle/syringe rinsed in cytology fixative

d. Salivary Gland FNA
1.       1-2 air-dried smears
2.       1-2 fixed smears
3.       needle/syringe rinsed in cytology fixative

e. Subcutaneous Nodule FNA
1.       1-2 fixed smears
2.       needle/syringe rinsed in cytology fixative

      Steps in preparation of smears and cell blocks
1.       Separate the needle from the syringe.
2.       Fill syringe with air.
3.       Reconnect the needle to the syringe.
4.       Gently express one drop of the needle content onto a clean glass slide.
5.       Place another glass slide on top of the expressed material and pull the slides apart. Try to keep the   material within a small area of the slide.
6.       Fix slide (or air-dry, if required).
7.       Rinse the needle in cytology fixative. This material may be very valuable; do not discard.

NOTE:  Upon request, the NGMC pathologists will perform FNA biopsies.  Please contact the Cytology Department to schedule.

D.      Cytogenetic Material
1.       Have the patient rise his/her mouth and brush their teeth before scraping.
2.       Label a clean glass slide with the patient’s name in pencil.
3.       Gently but firmly draw a tongue depressor (which has been soaked in distilled water) forward several
          times along the buccal mucosa.  Avoid the white dentate line.
4.       Quickly smear the milky material onto a clean glass slide and immediately fix in 95% alcohol
          or spray fix.
5.       Make at least 4 smears.
6.       Completely fill out the pathology request.
7.       Place the specimen and the request in a biohazard bag.
8.       Submit to the Cytology Department.

E.       Tzanck Prep for Viral Inclusions
1.       Label a clean glass slide on the frosted end with the patient’s name (in pencil).
2.       Clean area to be sampled with Betadine and/or alcohol.
3.       Firmly scrape lesion area with tongue depressor or scrape with sterile blade.
4.       Using a scalpel blade, scrape over the lesions
5.       Smear the material collected onto the glass slide.
6.       Fix immediately in 95% alcohol or spray fix.
7.       Completely fill out the pathology request.
8.       Place the specimen and the request in a biohazard bag.
9.       Submit to the Cytology Department.