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 Cytyc T2000 and T3000 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. 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 12:00 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 smears 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.

SPECIMEN REJECTION:

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PROCEDURES FOR COLLECTION OF SPECIMENS:

FEMALE GENITAL TRACT - CERVICAL VAGINAL CYTOLOGY:

Cervical -Vaginal Cytology Using Thinprep Method:
Obtain an adequate sample from ectoervix 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 transprt 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.

Samples for Hormonal Evaluation (Maturation Index) must be taken from the deep lateral vaginal wall. Pertinent Clinical Information, especially patient's age and menstrual history is necessary.

The Pap smear is a screening test used as an aid in detecting cervical cancer and its precursors. Published data indicates that Pap smear tesing 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 Cytyc T2000 and T3000 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.

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RESPIRATORY TRACT:

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.

BRONCHIAL:

Bronchial Washing: Send washings to the cytoprep laboratory immediatley. Do not fix. Specimens should not be sent through the tube station due to leaking of the vacutainer specimen holders.
Bronchial lLavage: Leave specimen in syringe or aspirate into a centrifuge tube, Do not fix.
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.

CEREBROSPINAL FLUID:

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 requistion form that they be kept separate. Multiple specimens on the same patient done at different times will be processed separately.

DO NOT ADD FIXATIVE.

BODY CAVITY FLUIDS (PLEURAL, PERICARDIAL, PERITONEAL):

Submit in container collected. Send fresh specimen to the laboratory. DO NOT ADD FIXATIVE.

JOINT FLUID:

URINARY TRACT: (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 or 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!

WOUND OR LESION SCRAPING:

Scrape the wound with moistened tongue blade or scrape with the edge of scapel blades and place the material directly on the slide. Place the slide immediately in 95% ethanol or spray with an 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.

BREAST:

Nipple massage or discharge:

Smear directly onto slide, spray fix immediatley or drop into jar of 95% ethanol. Do not allow to air dry.

 

Cyst fluid:

Submit as obtained. DO NOT ADD FIXATIVE.

FINE NEEDLE ASPIRATIONS:

Fine needle aspiration specimens should be submitted to the lab as syringes with needles still attached as soon as possible after aspiration. If there is no visible material in the syringe, it is usually advisable to make direct smears immediately after aspiration. Half of the smears should be air-dryed (will be stained with Diff-Quick) and half should be fixed (will be stained with Pap stain). Fixed slides should be placed in 95% ethanol vial (available from the Cytopathology lab) immediately after they are performed and smeared. Material left in the syringe can be aspirated into a centrifuge tube and the needle disposed of in a proper container.

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 843-1477.

CT DIRECTED OR DEEP ORGAN ASPIRATES:

The Cytopathology Lab provides immediate preliminary interpretation service for Radiology. These services should be scheduled in advance by consulting with the Cytopathology Service (843-1477).