LifeBridge Health - Department of Pathology
Cytopathology service for LifeBridge Health is provided at a consolidated core laboratory located at Sinai Hospital of Baltimore.
|Hours of Operation:
|Reports and Information
||Monday-Friday: 0730 – 1700 (SHB)
||Monday-Friday: 0730 - 1700
|After Hours Receiving
||Undercounter refrigerator, Central Specimen processing area
|Night, Weekends, Holidays:
||Contact page operator at x5901; ask for anatomic pathologist on call
||Third Floor, Main Hospital Laboratory
||410-601-5104 (extension 25104)
Request Forms: All specimens must be accompanied by a properly prepared and completed Cytopathology Consultation Request Form.
Inpatient: Patient information label, specimen source, clinical information, physician name and signature and date of procedure.
Outpatient/Outside Patient: Patient information must include name, address, date of birth, social security number, physician name and signature, specimen source, pertinent clinical information and insurance/billing information.
Specimen Fixative Containers: Containers containing CytoLyt™ solution available 24 hours a day in cabinet above the under counter sink in Cytology specimen processing area.
Specimens Requiring Special Handling:Fine Needle Aspirations (FNA) - call x25104 to schedule (Monday - Friday 0800 to 1700.)
Cytology Rejection Policy: Specimens with the any of the following problems will not be processed unless the problem can be resolved.
- Slide/specimen without accompanying requisition form
- Slide/container/requisition form lacking appropriate patient identifiers
- Slide/container/requisition with discrepant information
- Slide broken beyond repair
- Fresh specimens deemed too old for reliable results or non-refrigerated
- Specimens received in PreservCyt Solution with expired expiration date.
- No signature of requesting physician
Transportation: Specimen delivery is provided daily by hospital personnel and courier
Results: Final reports are accessible by Cerner Powerchart. Copies of final reports are distributed to all listed physicians and specimen location. NOTE: Gynecologic specimens (i.e. cervical, endocervical, vaginal) are reported using descriptive terminology that employs the Modified Bethesda System for gynecologic samples.
Cytopathology: Gynecologic Specimens
Patient Preparation: Certain factors (e.g. menstruation, creams, lubricants, douches) can affect the quality and accuracy of the Pap smear. A woman can improve the quality of her smear if she is instructed to:
- Avoid douches, vaginal medications or vaginal contraceptives for 24 hours before the examination.
- Avoid sexual intercourse for 24 hours before the examination.
- Visit her gynecologist 1-2 weeks after the end of menses.
- Record the date of her last menstrual period.
- Inform the gynecologist about any prior abnormal Pap smears, surgery, treatment for vaginal infections, current medications, symptoms, etc.
Cytology Requisition: Complete records are important to ensure accurate data from previous testing and enable the laboratory to obtain prior Pap smears and histologic slides for comparison of an abnormality. In order to comply with the Department of Health and Human Services (DHHS) regulations (CLIA '88) published on February 28, 1992, laboratories require the following patient information.
- Patient name, sex, age, date of birth, complete financial numbers if applicable.
- Site sampled (combined vaginal pool, endocervix, ectocervix, vaginal wall, vulvar)
- Referring physician name and signature
- Date of collection
- Last menstrual period (LMP)
- Pertinent clinical information: previous abnormal report, method of birth control, hormonal therapy, gynecologic surgery, radiation exposure, risk factors for developing cancer etc.
Cytopathology Gynecological Sampling and Collection
Thinprep™ Pap Test Specimen Collection:
Purpose: The ThinPrep™ 2000 System is intended as a replacement for the conventional method of Pap smear preparation for use in screening for the presence of atypical cells, cervical cancer, or it's precursor lesions (LGSIL, HGSIL) as well as other cytologic categories as defined by the Bethesda System for Reporting Cervical Cytology.
Specimens: Vaginal, cervical and endocervical sampling.
Supplies: This test requires ThinPrep™ Pap test supplies, Cytopathology requisition and a permanent marker.
Verify PreservCyt vial expiration date and label vial with app patient identifiers, specimen source and date of collection. Obtain specimen prior to bimanual examination. Use an unlubricated speculum (saline or warm water may be used). After visualization of the cervix is accomplished, collect the sample. Obtain an adequate sampling from the cervix using a broom-type (e.g. Wallach) collection device or endocervical brush/plastic spatula combination (following NCCLS guidelines GP-15A).
BROOM Collection: 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-type collection device into the PreservCyt™ Solution vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the collection device vigorously to further release material. Discard the collection device.
BRUSH/SPATULA Collection: Obtain an adequate sampling from the ectocervix using a plastic spatula. Rinse the spatula into the PreservCyt™ Solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula. Insert the brush into the cervix until only the bottom most fibers are exposed. Slowly rotate or turn one-half turn in one direction. DO NOT OVER-ROTATE. Rinse the brush in the PreservCyt™ Solution by rotating the devise in the solution while pushing against the vial wall. Swirl. Tighten the cap so that the torque line on the cap passes the torque line on the vial. Complete the Cytopathology Requisition including the Physicians signature (required by Maryland State Law).
Place the vial in the inner pouch of a double biohazard bag and place the Cytopathology requisition in the outer pouch to avoid possible contamination of the paper work.
Cytopathology: Non-Gynecologic Specimens
- Non-gynecologic specimens are not to be sent to the lab using the pneumatic tube system. These specimens must be manually delivered to the lab.
- Specimens must be placed in double pouch biohazard bag being careful to separate the Cytopathology requisition from the patient sample.
- Cytopathology will make every attempt to process specimens. However, if delays in delivery have occurred which may render the specimen unreliable, it will be discarded and/or a disclaimer as to its validity will be made in the final cytology report.
- The submitting physician will be notified of unsatisfactory specimens and a repeat specimen will be requested.
- During hours when the laboratory is closed, questions concerning specimen processing may be addressed by contacting the on call Pathologist through the page operator of the hospital.
Urinary: Patients should be well hydrated before collecting urine. Any instrumentation must be noted on the requisition form. Delay in delivery to the laboratory should be avoided. If necessary, refrigerate the specimen until the time of transportation to the laboratory. Collect the urine fresh or with equal volumes of CytoLyt™. For routine urine collection, emphasize the need for a clean catch specimen. Random mid-day collection is preferred. Discard first morning specimen.
Sputum: Sputum must be deeply coughed from the lungs. Avoid oral contamination and saliva. The best collection time is early in the morning upon rising. The specimen should be received in the laboratory as soon after collection as possible. Refrigerate the specimen until the time of transport. Deep cough specimens are the most reliable sputum sample.
Body Cavity and Joint Fluids: In general, these specimens are submitted fresh to the laboratory. If clotting presents a problem, fluids and effusions may be collected in a bottle containing 3 units of Heparin/ml of anticipated fluid. Refrigerate all specimens until the time of transportation. Otherwise, collect the fluid with an equal volume of CytoLyt™ cytology fixative.
Cerebrospinal Fluid (CSF): Place the fluid in a clean vial. Prompt delivery (preferably within 30 minutes) to the laboratory is essential since CSF cells deteriorate rapidly. Refrigerate until time of transportation.
Gastric, Esophageal, Duodenal, Colonic Brushes: After collecting the specimen, swish the brush in CytoLyt™ cytology fixative. Leave the brush in the solution for transportation to the Cytology laboratory.
Submission of-Prepared Slides: Specimen examples include: oral, nipple discharges, imprints, scrapings
- Write the patient's name on the frosted end of the slide with pencil before beginning. After the slide is wet, the pencil will not write as easily.
- Hold the slide with the thumb over the frosted end of the slide.
- Hold the spray container at 6- 1 0 inches from the slide to avoid blasting the material on the slide.
- Begin the spray at the thumb end in the event that the first gush of spray from the container is air.
- Cover the specimen completely with fixative. The slide must be glistening wet.
- Allow 10 minutes drying time before placing the slide in the folder for transport to the laboratory. This is especially important if a barcode label is to be applied to the folder. A wet folder will render the barcode unreadable.
- Check to ensure that the name on the slide, slide holder and requisition form match.
WARNING: Any air drying will result in poor cytologic detail and potentially cause unsatisfactory results.
Fine Needle Aspirations (FNA): Cytotechnologists are available on during normal hours of operation to assess the adequacy of the FNA sample. It is desirable to schedule these procedures in advance with Cytology to insure the availability of the technologist. Contact the Cytology Laboratory at 601-5104 (SHB) or 521-5910 for scheduling and to obtain immediate assistance.
Unassisted Fine Needle Aspirations (FNA): If the fine needle aspiration (FNA) is performed without the assistance of the cytotechnologist, please note the following procedure:
- Write the patient's name on each slide (4-6 as needed) using a lead pencil.
- Have a container of CytoLyt™ Fixative open and ready.
- Place a drop of the material at 1/8 inch below the frosted end of the slide.
- Hold a hemacytometer coverglass or second slide between the thumb and forefinger.
- Place the coverglass at the bottom of the drop allowing the drop to flow to the edges.
- Using a quick motion, push the coverglass toward the frosted end and then toward the opposite end of the slide.
- If the drop is adequate, the smear will be thin and should reach the end of the slide.
- If the drop is too large, the hemacytometer coverglass should not be used. Use the two slide pulled together technique.
- Make two slides from each pass
One slide: air-dried and placed in a plastic slide holder.
One slide spray-fixed or placed immediately in 95% alcohol solution.
- Rinse the needle and syringe with CytoLyt™ fixative and submit with the prepared slides to Cytology.
- Submit to the Cytopathology Department.
Respiratory Tract Specimens:
- Bronchial brushings: After collecting the specimen with the brush, swish the brush in CytoLyt™ fixative. Leave the brush in the solution for transportation to the Cytology laboratory.
- Bronchial washings: Collect the bronchial washings into jars containing CytoLyt™ alcohol cytology fixative for transportation to the Cytology laboratory.
- Transbronchial needle aspiration (TBNA): Collect the aspirated material and express into CytoLyt™ Solution for transportation to Cytology.
- Bronchoalveolar lavage (BAL): After collecting the specimen, express the material into jars containing CytoLyt™ cytology fixative for transportation to the Cytology laboratory.
- Post-bronchoscopy sputum: See Sputum description above.