Cytology
Short Description : Pathology of cells and body fluids
Also known as : [Cytopathology]

Tissue
Test performed by: Auckland Hospital

Scope of Non-Gynaecology Cytology Examination

While the primary purpose of the cytology examination of Non-gynaecological specimens is to detect malignancy, the method may also detect inflammatory or infectious disorders and other conditions.

Reliable cytology diagnosis of non- gynaecology material depends on sufficient patient history and quality slide preparations.

Standard Precautions

Most of the Non- gynaecological specimens are fresh and must be processed as soon as possible.

If a delay in processing is anticipated, then some form of specimen preservation may be needed, such as the use of fixatives and preservatives.

Refrigeration of fresh specimens temporarily preserves cells by suspending their metabolic processes. At room temperature (22 to 25?C), specimen integrity is maintained for approximately six hours before it is significantly compromised. Exceptions include urine, CSF and vitreous fluid, which may degenerate within one hour, even with refrigeration.

Because it is often impossible to know what isolates or specimens might be infectious, all patient and laboratory specimens are treated as infectious and handled according to "standard precautions".

Specimen Collection
Bronchial Specimens

Bronchial Washings and Brushings; Bronchial Alveolar Lavage for Cell differential,

Hemosiderin Laden Macrophages (cytology)

The brushing implement used to sample the respiratory tract can be inserted and rinsed in saline.

Bronchial washings must be collected into a sterile container and sent to the

laboratory as soon as possible.

Bronchial Alveolar Lavage (BAL) specimens must be transported in a sterile container on ice (placed in a separate outer bag) and sent to the laboratory immediately for processing.

If BAL specimens are received outside of normal working hours, please send it to Microbiology. Microbiology will perform BAL differentials, prepare unstained slides and deliver to Cytology for testing the following working day.

Lipid laden macrophages (cytology):

This test is not recommended.

Quantification of lipid laden macrophages by cytology is not standardised and not reliably reproducible.

At the present, the existing literature indicates that enumeration of lipid laden macrophages is NOT a sensitive or specific marker for aspiration.

Elevated lipid indices can be found in a variety of pulmonary diseases, independent of aspiration.

REFERENCES

Krishnan, Usha; Mitchell, John D.; Tobias, Vivian; Day, Andrew S.; Bohane,Timothy D. Fat Laden Macrophages in Tracheal Aspirates as a Marker of Reflux

Aspiration: A Negative Report. Journal of Pediatric Gastroenterology &Nutrition: September 2002 - Volume 35 - Issue 3 - pp 309-313

Rachel Rosen, Julia Fritz, Ariela Nurkoa, Dawn Simon, and Samuel Nurko.Lipid-Laden Macrophage Index Is Not an Indicator of Gastroesophageal Reflux-Related Respiratory Disease in Children. Pediatrics. April 2008 -volume 121 ? issue 4, e879?e884.

Knauer-Fischer S, Ratjen F. Lipid-laden macrophages in bronchoalveolar lavage fluid as a marker for pulmonary aspiration. Pediatr Pulmonol. 1999 Jun;27(6):419-22. doi: 10.1002/(sici)1099-0496(199906)27:6<419::aid-ppul9>3.0.co;2-u. PMID: 10380094.

Serous or Cyst Fluids

An ideal volume of 50-100mL of fluid is preferred for cytological examination.

The fluid should be collected into a clean, dry container or a screw top bottle which need not be sterile and sent to the laboratory as soon as possible.

If it is not possible to send the fluid immediately, it should be stored in a refrigerator at 4C and not allowed to freeze.

Addition of anticoagulants or fixative to the fluid is not required.

Sputum

An early morning (before breakfast and teeth washing) deep cough specimen in a clean container is preferred.

Saliva is unsuitable for assessment. Physiotherapy may assist in the production of the specimen.

Sensitivity is increased when three specimens are taken on three consecutive days.

Urine Samples

A 2-3 hour whole output specimen greater than 50mL is required.

Early morning urine is NOT satisfactory because of advance cellular degeneration in urine overnight.

Because cells degenerate quickly in an acid medium, an equal volume of 50% alcohol to enhance fixation should be added to all urine and bladder wash specimens.

The specimen should be transported to the laboratory on the day of collection.

Cerebrospinal Fluid (CSF)

CSF is often shared with Microbiology/Haematology Departments who process the specimen first. They prepare 2 cytospin slides for Cytology.

Please refer to LabPlus Test Guide -Haematology - CSF Cytology for Specimen collection and transportation .

CSF

Vitreous/Aqueous Fluid/Biopsy

Cytology testing is only for Metastatic melanoma/carcinoma. If queries are for other diseases, send directly to the appropriate department (see table below).

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It is recommended for specimens to be immediately transported to the laboratory and kept cool. If immediate transportation is unavailable, place the specimen into a sterile container and refrigerate.

Please call Cytology section before the operation to notify ALSS of an urgent sample arrival.

Bile duct brushing

The brushing implements used to sample the gastrointestinal tract can be inserted and rinsed in Cytolyt solution (provided by the laboratory).

Fine Needle Aspirations (FNA)

The yield of diagnostic information is directly proportional to adequate aspiration technique and preparation of material. Correct and relevant clinical information must be provided if delays in reporting are to be avoided.

Consultation with the laboratory is advised, and every effort is made to provide technical and professional assistance.

Slides should be thinly spread and rapidly air-dried and normal saline used for the needle rinse.

Aspiration of extra material for microbiological culture/Flow cytometry should be considered if an infectious aetiology/ Lymphoma are deemed to be possible.

Accurate labelling of specimens intended for Cytopathology and Microbiology is essential and sent to the laboratory as soon as possible.

Rapid on-site evaluation (ROSE) with EBUS, CT or Ultrasound-guided FNA

When Cytopathologists are requested to attend or perform FNA biopsies, a provisional opinion will be given on-site followed by a formal report after reexamination of the specimen in the laboratory.

Specially trained Cyto-scientists may attend ROSE under Ultrasound-guided Head and Neck FNA and EBUS to assess sample adequacy to support Radiologists/Physicians.

We can no longer do free hand FNAs on outpatients at LabPlus but we will attend the clinics or wards.

To book a Cytopathologist to attend or perform an FNA, please contact the Anatomical Pathology secretary on ext 21767 Monday to Friday.

When Pathologists are unable to attend FNA

All material sampled by Radiologist/Physician are rinsed in:

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Gynaecological Cytology

From 18 th January 2021, LabPlus no longer process Gynaecological Cytology specimens.

ThinPrep Pap test samples are transferred to APS Mt Wellington.

SurePath Pap test samples are forwarded to LabTests.

Turnaround Time (TAT)

Normally five working days, but this may vary depending on the complexity of individual cases and whether additional laboratory tests are required.

An exception to this TAT: Peritoneal washing specimens accompanying Gynae oncology histology specimens are reported by Gynae-oncology pathologists.

Laboratory Hours and Contact Information

Laboratory Hours are Monday to Friday between 0830 to 1700.

For enquiries and results, use ward computer or phone LabLink: 22000 or (09) 307- 8995 or 0800 522 758.

Cases requiring further discussion or preliminary reports will be communicated by telephone from laboratory medical staff (Pathologist or Registrar) to clinical medical staff.

For all Office enquiries and FNA booking, please contact 21767.

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Last updated at 06:59:55 19/02/2024