All unfixed Cytology cell samples will begin to degenerate from the moment of collection, thereby rendering them difficult to interpret and potentially unsuitable for diagnostic purposes.  In the interests of the patient, it is advisable that they be transported to the laboratory for processing as soon as is possible to minimise autolysis and promote accurate and timely reporting.To facillitate this, specimens must arrive in the laboratory correctly labelled and packaged and accompanied by an appropriate request form completed with the minimum data set and all relevant patient and clinical details.

SPUTUM CYTOLOGY

Early morning deep cough specimens resulting from overnight accumulation of secretions yield the best diagnostic results.  A single specimen taken on each of three consecutive days should be sent to the laboratory for analysis as soon as it is collected to maximise diagnostic accuracy.  The patient must be carefully instructed not to spit without a deep cough as saliva is of no diagnostic value. The specimen sent is randomly sampled and 5-10ml is regarded as the minimal optimal volume requirement for this test.

FLUID CYTOLOGY

Examples of these include,  pleural or ascitic effusions, peritoneal washings, breast cyst fluid, hydrocele fluid and ovarian cyst fluid. These should be sent fresh, directly to the laboratory or kept refrigerated until transported.  A maximum of 25 mls of the sample should be delivered to the laboratory in a sterile universal container for processing. Do not send drainage bags as transport and disposal of large quantities of unfixed fluid present health and safety risks.

URINARY TRACT CYTOLOGY

A freshly voided or catheter sample  should be collected into  250ml urine pots and sent directly to the department.  If this is impossible refrigerate and transport at the first available opportunity.  The second full voided specimen of the day is optimal for accurate cytological assessment.  Avoid sending the first specimen of the day i.e. an early morning urine, as this has the disadvantage of marked cellular degeneration.  Urine bottles are available from the Cytology department. Please indicate if it is a catheter sample.

BRUSH CYTOLOGY

Examples of these include , gastric, rectal, oesophageal, and bronchial brushings.

Using clean slides, clearly label the frosted  end in pencil, with patient name and PID as a minimum. Spread sample by rolling the brush along the slide. Preparations must be fixed immediately with an alcohol based fixative to preserve the material. Immediate fixation is essential to promote and enhance staining and subsequent accuracy of reporting. 

Brushes used for liquid based cytology preparation must be thoroughly rinsed in  10 ml of CytoLyt a preservative used in Liquid Based Cytology (LBC) as soon after collection as possible.  Any delay in this process may compromise both the quality and quantity of diagnostic material shed from the sampler into the vial and result in potentially suboptimal preparations upon which the diagnosis may be based.

Place slides in a slide carrier (ensure they are separated)  for transportation

FINE NEEDLE ASPIRATION  CYTOLOGY (FNAC)

Examples of these include aspirates from, breast, lymph node, thyroid, and salivary gland .Slides prepared in the clinic for FNAC may either be air-dried and/or alcohol fixed and will be stained in the laboratory accordingly. 

Using clean slides, clearly label the frosted end in pencil with the Patient's name and PID as a minimum. Label slides also with the fixation used ie: wet or dry

It is imperative that specimens are spread thinly and  either wet fixed and or dry fixed immediately , to promote optimal staining and therefore accuracy of reporting.

Wet preparations must be fixed using an alcohol based fixative and dry preparations waved in the air to promote drying.

Residual material from the needle may be rinsed into  10 ml of CytoLyt and transported to the laboratory to be processed for LBC.

Place slides in a slide carrier  (ensure they are separate) for transportation.

Endobronchial Ultrasound Guided Trans-bronchial Needle Aspirate Samples (EBUS)

These samples are processed as for  FNAC.  The needle is washed out in 10 ml CytoLyt solution, sent to the laboratory and processed as for LBC.

CEREBROSPINAL FLUID

These specimens are particularly delicate and require immediate preparation to prevent cellular degeneration.  They must be sent directly to the laboratory in a sterile universal container clearly labelled with the patient's name and PID.  If sending after 16:00 please inform the laboratory at the earliest opportunity prior to despatch to ensure staff availability for timely preparation. Sample volume obtained from the patient for this test is usually less than 1ml hence all material sent is usually processed.

BRONCHOALVEOLAR LAVAGE CYTOLOGY (BAL)

(for differential cell count)

These specimens must be in as near a natural state as possible for accuracy of reporting.  They must be collected into a sterile, labelled universal container and packed on ice and transported immediately to the laboratory for preparation to prevent cellular degeneration.  Sample volume obtained from the patient for this test is variable however 30 ml is the expected average.  Receipt of BAL samples during the early part of the working day is encouraged to enable processing and preparation of the slides.  If the sample is expected to be received after 16:00 pm the department must be telephoned.

Bronchoalveolar Lavage samples for Cytology must be sent to the laboratory on ice - this is essential to ensure minimal cell degeneration. They should be packed in ice, sealed and delivered to Pathology by a porter. Please inform the lab of their expected arrival time, to ensure staff are available to process the sample.

SYNOVIAL FLUID CYTOLOGY (for crystals)

These specimens must be sent in a sterile white capped universal container. Please ensure the request form is clearly labelled "for crystals". 5ml is an optimal  sample  volume for processing and reporting.

Miscellaneous  Non-Gynae Samples

Please contact the Cytology laboratory for advice regarding unususal samples.

Factors affecting performance

Please ensure that samples arrive in the laboratory as soon as possible after collection as unfixed cells degenerate quickly 

Please ensure that unfixed material spread onto glass slides following FNA procedures are air dried rapidly to facillitate staining

Please ensure that cytology brush specimens spread on glass slides are fixed immediately with spray fixative to prevent cellular autolysis

Please ensure that material left over from cytology brush samples are immersed in fixative solution (PreservCyt) immediately following procedures.

Please inform the laboratory of any urgent samples to facillitate reporting times