Beth Israel Deaconess Medical Center
Laboratory Manual
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GUIDELINES FOR CYTOPATHOLOGY SPECIMENS

Specimen type
Volume or No. Desired
Container
Fixative
CSF
1 ml
CSF tube
No
Sputum
1/day for 3 days
Non-sterile cup
No
Urine (from outside the
hospital)
50 ml
Cytolyt
Yes
(Cytolyt)
Urine (inpatient)
50 ml
1/day for 3 days
Non-sterile cup
No
Washings (bronchial, gastric, esophageal)  
Non-sterile cup
No
Other Body Fluids
50 ml
Non-sterile cup
No
Brushings. Remove the brush from the sheath, hold the brush over a 50 ml tube containing Cytolyt fixative, cut the shaft of the brush and allow the brush to fall into the Cytolyt fixative.

Fine Needle Aspiration.  Express the material into a 50 ml centrifuge tube containing Cytolyt fixative. Carefully remove the needle from the syringe. Pull some of the fixative into the syringe, put the needle back on the syringe and express the contents into the tube.  (Note: a cytotechnologist or cytopathology fellow is available weekdays from 8:00 AM to 5:00 PM to render an adequacy determination.  It is necessary to schedule 24 hours in advance with the Cytology Department by calling the lab at 617-667-2950.)

For Cervical smears, Nipple Discharge or Tzanck preparations, label glass slides with the patient’s name, date and time of the collection.  After collection according to the following instructions, fix the slide immediately as described at the end of this section.

Cervical smear.  With the patient in the lithotomy position, insert speculum, without using lubricant other than warm water, and visualize the cervical os. Insert a cytobrush into the endocervix and take a circumferential sample by turning the brush a minimum of ¼ turn. Gently roll the brush back and forth down the entire length of the slide, striving to obtain a uniform monolayer of cells.  (Please see below for instructions on ThinPrep Pap test.)

Nipple discharge.   Gently squeeze the nipple and allow only a pea-sized drop of secretion to accumulate. Touch the slide to the nipple and withdraw it quickly.

Tzanck prep .  Touch the slide to the open lesion, getting fresh exudate.

Fix the slide immediately. A delay in fixation of even a few seconds will render the slide very difficult to interpret due to cellular distortion and enlargement with nuclear ballooning. Use either cytology spray fixative (hold the spray bottle of fixative approximately 6 inches from the slide and spray evenly, thinly coating the specimen) or 95% ethanol. After fixation, allow the slide to air dry. Once it is dry, place it in a cardboard mailer.

ThinPrep Pap.  Prepare the patient the same way as for obtaining a cervical smear.  Obtain an adequate sampling from the cervix using a broom-like device or endocervical brush/plastic spatula.

Broom-like device.  Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix.  Push gently, and rotate the broom in a clockwise direction five times.  Rinse the broom as quickly as possible into the PreservCyt Solution vial by vigorously pushing the broom into the bottom of the vial 10 times, forcing the bristles apart.  As a final step, swirl the broom vigorously to release material.  Discard the collection device.

Endocervical brush/plastic spatula.  Rinse the spatula as quickly as possible into the PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times.  Discard the spatula.  Rinse the brush as quickly as possible in the PreservCyt Solution by vigorously pushing against the PreservCyt vial wall 10 times.  Swirl the brush to further release material.  Discard the brush.
Revised/reviewed 2/12/2010
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