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):
TEST NO LONGER OFFERED
It is now widely recognised that the finding of lipid-laden macrophages is not a sensitive or specific marker for reflux aspiration or other forms of lung damage.
It also cannot distinguish between endogenous and exogenous lipid.
Therefore from May 31 st 2024 onwards , the Auckland City Hospital cytopathology department will no longer be performing ORO staining on BAL specimens, and no test requests for fat-laden macrophages will be accepted
REFERENCES:
Torous VF, Brackett D, Brown P, Edwin N, Heidarian A, Lobuono C, Sun T, Pitman MB, Ly A. Oil red O staining for lipid-laden macrophage index of bronchoalveolar lavage: interobserver agreement and challenges to interpretation. J Am Soc Cytopathol. 2020 Nov-Dec;9(6):563-569.
Jebastin Thangaiah J, Booth CN, Brainard JA, Elsheikh TM, Reynolds JP, Ondrejka SL, Thilagar BP, Mukhopadhyay S, Doxtader EE. Oil Red O Staining of Pulmonary Macrophages in Bronchoalveolar Lavage Specimens Is Not Specific for Vaping-Associated Lung Injury. Am J Clin Pathol. 2022 Dec 1;158(6):723-729
Torous VF, Ly A. Correlation between cytology Oil Red O staining and lung biopsy specimens: utility of the lipid-laden macrophage index. J Am Soc Cytopathol. 2022 Jul-Aug;11(4):226-233
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
.
Cytology testing is only for Metastatic melanoma/carcinoma. If queries are for other diseases, send directly to the appropriate department (see table below).
Vitreous/Aqueous Fluid/Biopsy
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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.
The brushing implements used to sample the gastrointestinal tract can be inserted and rinsed in Cytolyt solution (provided by the laboratory).
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.
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.
All material sampled by Radiologist/Physician are rinsed in:
Bile duct brushing
Fine Needle Aspirations (FNA)
Rapid on-site evaluation (ROSE) with EBUS, CT or Ultrasound-guided FNA
When Pathologists are unable to attend FNA
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Gynaecological Cytology
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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