Cytopathology Laboratory

Cytopathology accepts and evaluates ThinPrep® (liquid-based) and Conventional Pap smears as well as a wide variety of specimens from a wide variety of non-gynecological body sites, including fine needle aspirations.

Cytopathology processes liquid-based Pap specimens with the Hologic T2000 and Hologic T5000 Processing systems. After processing, ThinPrep® Pap specimens are analyzed by the Hologic ThinPrep® Imaging System, an automated imaging and review system which assists the lab in the evaluation of cells in the ThinPrep® Pap test. Following automated imaging, selected fields from every slide are reviewed by a cytotechnologist. All abnormal specimens are reviewed by a cytopathologist.

The turnaround times for Cytopathology specimens are as follows: routine gynecological specimens is 7 day, rush gynecological specimens is 48 hours; routine non-gynecological specimens is 48 hours, rush non-gynecological specimens is 24 hours unless cell blocks or additional specialized staining is necessary.

All Medical Staff members are welcomed and encouraged to discuss any aspect of the services and/or patient results with the Cytopathologist. Reviews with the Cytopathologist should be set up by appointment.

• Routine specimens are handled through Core Laboratory and picked up routinely by Anatomic Pathology personnel.
• Specimens that need immediate delivery should be delivered by ward/unit personnel.
• Specimens collected outside of Lab hours should be placed UNFIXED in the refrigerator adjacent to the Cytopathology Laboratory.
• Specimens received by noon are processed the same day.

• Requisition forms are ordered from Corporate Express.
• Vials for collection of Thin Prep pap smears and brushings from non-gyn sites.
• (ThinPrep PreservCyt) such as bronchial brushings and GI brushings are also obtained from the laboratory.
• Request Forms (requisitions) must be filled out on all specimens and contain patient name, medical record number, requesting physician, physician code, pertinent clinical history, any special studies (such as special stains) requested and source of specimen.
• GYN pap samples must also include insurance information (Medicare or non-Medicare), indication of a screening vs. diagnostic Pap smear (along with appropriate ICD-9 codes), last menstrual period, history of prior GYN abnormalities.

The Laboratory reserves the right to reject specimens that are submitted in an improper manner. Criteria for rejection include:

• Unlabeled specimens (gyn and non-gyn)**
• Specimen container and requisition mismatches
• Vital information not given on the Cytopathology Request Form
• Unacceptable packaging of the specimen
• Requested test not performed in the Laboratory
• Specimen from an unauthorized source
• Broken slides (fragmented beyond repair)
• Inadequate material for processing

**Specimen identification is critical for accurate result reporting. Healthcare accrediting agencies (i.e. Joint Commission, CAP) address this patient safety concern by requiring that specimen containers, each glass slide, and tube be labeled with at least 2 patient identifiers.

Acceptable patient identifiers include:

• Patient last name and first name, and one of the following:
  • Patient date of birth
  • Patient medical record number

The EPIC specimen label is acceptable on container or tubes containing fluid samples.

For glass slides, please use pencil to write the patient identifiers directly on the frosted end of the slide. A paper label is NOT acceptable as a patient identifier on glass slides, as the information will be washed off when the specimen slides are prepared for microscopic review. Labeling the outside of a cardboard holder is NOT acceptable, unless the slides contained within are also labeled with 2 patient identifiers as well.

Specimens sent to Cytology unlabeled will not be processed which will cause a delay in reporting test results or cancellation.

Cervical -Vaginal Cytology Using Thinprep Method:

• Obtain an adequate sample from ectocervix by using a plastic spatula and rotating it 1 1/2-2 times.
• Rinse the spatula into PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.
• Obtain an adequate sample from endocervix using and endocervical brush device. Insert the brush into cervix until only the bottommost fibers are exposed. Slowly rotate 1/4-1/2 turn in one direction. Do not over-rotate.
• Rinse vigorously the brush in the same vial of PreservCyte by rotating it 10 times while pushing against the vial wall. Discard the brush. Tighten the cap on the vial.
• Record the patient's name and ID on the vial. Fill out the requisition form with patient's history. Place the vial and requistion in a bag for transport to the lab.

Cervical-Vaginal Cytology conventional Smears:

• The patient's name, MR# and source of specimen must be written in PENCIL on the frosted end of the slide BEFORE THE SMEAR IS TAKEN AND SPREAD.
• An endocervical swab, aspirate or brush is recommended.
• The endocervical sample should be obtained and placed on the slide before the smear is made with the spatula or placed on a separate slide.
• Obtain the cervical scraping from the complete transformation zone by rotating the spatula 360 degrees around the cervix at least twice.
• With the spatula, spread the material obtained rotating in a clockwise fashion on the clear end of the slide and spray immediately with an appropriate fixative keeping the spray nozzle 12 inches from the slide surface. DO NOT ALLOW SMEAR TO AIR DRY!
• A vaginal pool sample is rarely of value in screening for cervical carcinoma.
• Maturation index is no longer performed
• The Pap test is a screening test used as an aid in detecting cervical cancer and its precursors. Published data indicates that Pap testing is subject to both false negative and false positive results. It is NOT a diagnostic procedure and should not be used as the sole means of detecting cervical cancer. Periodic repeat testing and follow-up of any unexplained clinical signs and symptoms are recommended.
• UNC Healthcare processes liquid-based Pap specimens with the Hologic T2000 and T5000 Processing systems. After processing, ThinPrep® Pap specimens are analyzed by the Cytyc ThinPrep® Imaging System, an automated imaging and review system which assists the lab in the evaluation of cells in the ThinPrep® Pap test. Following automated imaging, selected fields from every slide are reviewed by a cytotechnologist, and a pathologist if necessary.

Sputum:

• Instruct the patient to cough deeply (from the diaphragm) to expectorate a deep cough specimen and not saliva.
• For best results, a series of early morning specimens should be obtained over a period of three consecutive days, submitting one specimen each morning for three days.
• Sputum can be expectorated directly into a specimen cup and left unfixed. DO NOT ADD FIXATIVE.

Bronchial:

• Bronchial Washing: Send washings to the cytoprep laboratory immediatley. DO NOT ADD FIXATIVE. Specimens should not be sent through the tube station due to leaking of the specimen holders.
• Bronchial lavage: Leave specimen in syringe or aspirate into a centrifuge tube, DO NOT ADD FIXATIVE.
• Bronchial Brushings: Place bronchial brush directly into a PreservCyt vial.

Pneumocystis:

In order of diagnostic yield and preference, the specimen should be:

1. Bronchial lavage
2. Bronchial washings/brushings
3. Induced sputum.

Flourescent antibody testing for pneumocystis is to be sent to the Microbiology Laboratory.

Submit in the tube collected in. Send fresh specimen (1-3 ml) directly to the Cytopathology lab.

Please note: If multiple tubes are sent from the same draw, they will be combined unless there is a specific request on the non-gyn requisition form that they be kept separate.

Multiple specimens on the same patient done at different times will be processed separately.

DO NOT ADD FIXATIVE.

• Submit fresh specimen-bulk collection container to the laboratory 50 mL of specimen or more is preferred.
• DO NOT ADD FIXATIVE.

• Send fresh specimen to laboratory. Indicate if any special stains need to be performed.
• Crystal analysis is done in the Core Lab, if this is needed send a portion of the specimen to Core Lab.

(Voided Urine, Catheterized Urine, Bladder Washings, Ureter Washings or Brushing, Renal Pelvis Washings or Brushings)

Cancer or Viral Detection: Send fresh warm urine, bladder washing, immediately to the Lab. Do not refrigerate. DO NOT ADD FIXATIVE. Due to chance of leakage, these specimens should not be sent through the tube system.

Estrogen Bioassay (for estimation of estrogen effect in female children): Collect Clean Catch Urine specimen only; send to Lab immediately. DO NOT CATHETERIZE, DO NOT REFRIGERATE!

(Esophageal, Gastric, Duodenal, Pancreatic, Bile Duct, Small Bowel, Colon, Rectum)

Washings: Send fresh specimen directly to lab. Indicate if any special stains need to be performed.

Brushings: Brushings may be placed directly into a PreservCyt vial.

Scrapings

• Scrape the wound with moistened tongue blade or scrape with the edge of scalpel blades and place the material directly on the slide.
• Place the slide immediately in 95% ethanol or SPRAY WITH APPROPRIATE FIXATIVE keeping the spray nozzle 12 inches away from the slide surface. 
• If the wound is hard and crusted, it should be soaked with warm saline prior to obtaining the scrape. 

• Scrape the wound with moistened tongue blade or scrape with the edge of scalpel blades and place the material directly on the slide.
• Place the slide immediately in 95% ethanol or SPRAY WITH APPROPRIATE FIXATIVE keeping the spray nozzle 12 inches away from the slide surface.
• If the wound is hard and crusted, it should be soaked with warm saline prior to obtaining the scrape.

Nipple massage or discharge: Smear directly onto slide, SPRAY FIX IMMEDIATELY or drop into jar of 95% ethanol. Do not allow to air dry.

Cyst fluid: Submit as obtained. DO NOT ADD FIXATIVE.

• Material from Fine needle aspiration specimens maybe submitted directly into a container of cytology fixative. Direct smears may also be submitted. 
• If direct smears are made, 1 fixed slide and 1 air dried should be prepared from each needle pass. Once smears are prepared, the needle should be rinsed into a container of cytology fixative. 
• Fixed slides may be spray fixed or immersed in 95% ETOH. 
• For Thyroid specimens requiring reflex molecular testing, 1-2 additional passes should be obtained and expressed directly into the appropriate transport medium (ThyrSeq or Afirma).

The Cytopathology Lab provides aspiration service and immediate preliminary interpretation for superficial masses and for CT directed or deep organ aspirates performed by radiology.

These aspirations should be scheduled in advance by consulting with the Cytopathology Service at 984-974-1477.

The Cytopathology Lab provides immediate preliminary interpretation service for Radiology.

These services should be scheduled in advance by consulting with the Cytopathology Service at 984-974-1477.