Cytopathology

The Cytology Laboratory provides a comprehensive non cervical cytology service. For PHNT report enquiries please contact 01752 792355 (int. 52355).

NON-CERVICAL CYTOLOGY

General Information
Cytological investigation of fluids, brushings and fine needle aspirates is performed. Immunocytochemistry is available to aid tumour diagnosis and classification in liquid specimens. >50% of non-cervical cytology specimens are reported within 5 days (date taken to date authorised). However, some, particularly more complex cases such as those requiring immunocytochemistry, may take longer.


Requests for non cervical cytology should be made on the Department of Cellular and Anatomical Pathology request form. Please ensure the type of requested investigation, i.e. non cervical cytology, is clearly marked on the form. If additional assessments are required, e.g. microbiology or clinical chemistry, multiple containers must be sent to the relevant departments. Each test requires a separate request form of appropriate type, which also applies to histology specimens taken in conjunction with a cytology sample.


All non cervical fluids with the exception of sputum samples are collected in tall, sterile white capped universal containers (25ml). Sputum samples are collected in wide necked containers. Containers, specimen bags and request forms are available from Pathology Issue Store ext. 52418.


IT IS IMPORTANT NOT TO SEND LARGE QUANTITIES OF FLUID – 25 MLS MAXIMUM IS ALL THAT IS REQUIRED.


It is essential that non cervical cytology samples are sent to the laboratory as soon as possible to ensure good preservation and to prevent bacterial overgrowth. If transport is delayed, specimens must be stored in a refrigerator. To ensure safe transportation, each sample is sealed in an individual specimen bag and kept separate from the request form (front pouch of bag).


HIGH RISK SPECIMENS MUST BE CLEARLY IDENTIFIED ON REQUEST FORM AND SPECIMEN CONTAINER.


Request forms should contain the following information:

  • Patient’s surname
  • Patient’s first name
  • DOB
  • Hospital number
  • NHS number
  • Specimen type/clinical history
  • Date/time taken
  • Clinician
  • Location

Specimen containers should be labelled with the following information:

  • Patient’s surname
  • Patient’s first name
  • DOB and/or hospital number
  • Specimen type
  • Date/time taken

Slides prepared in clinic should be labelled using a pencil with the following information:

  • Patient’s surname
  • Patient’s first name
  • DOB and/or hospital number
  • Type of fixation, e.g. ‘F’ for fixed preparations and ‘A’ for air-dried preparations.

Details of the specific fixation required for each of the specimens taken are given in the specimen collection section below.


Please ensure that the specimen is placed on the labelled side of the slide. Fluid specimens must be spread thinly (blood film technique).


Slide preparations requiring fixation are sprayed with Cytofix or immediately immersed in Industrial Methylated Spirit to prevent the specimen drying before fixation. Formalin should not be used as a cytology fixative. Slide preparations requiring air-drying should be dried as quickly as possible by agitating in air (any form of heating should not be used in this process). Both request form and slide preparation must state whether the preparation is fixed or air-dried. Absence of this information may lead to inappropriate processing rendering the specimen unsuitable for cytological assessment.

 

Specimen Collection

If Lymphoma is suspected and flow cytometry requested please send sample directly to Immunology Level 6 (int 52390). Do not send to Cytology as samples must be received for analysis as fresh as possible.

Bronchial Tract Specimens: Bronchial tract specimens include bronchial lavage samples and bronchial brushings. Bronchial lavage samples are suspended in saline. Please collect lavage sample in a 25 ml tall, sterile, white capped universal container containing an equal quantity of cytospin collection fluid. Brush specimens may be spread directly onto a slide and/or the head of the brush may be detached and placed in cytospin collection fluid for transportation. Direct preparations must be fixed to reduce the risk of infections associated with this specimen type. 


Cerebrospinal fluid (CSF): When sending CSF specimens for cytological examination (i.e. not microbiological/biochemical testing) to the Cellular Pathology Laboratory (ext, 52355) during normal working hours, please ensure that the sample is taken directly to the laboratory so that it is received before 4pm. 3-5 ml of CSF should be placed in a labelled, 25 ml tall, sterile, white capped universal container. No fixative should be added and the accompanying request form must be red spotted. If the sample is being sent to exclude malignancy, please send a minimum of 5ml and take the sample in the first part of the week (Monday – Wednesday), so that additional tests can be applied to the sample if necessary prior to the weekend.


If the sample needs to be taken out-of-hours (after 5.30pm or on weekends) as part of other urgent investigations e.g. for meningitis, the sample should be refrigerated overnight and delivered to the laboratory between 9 and 10am on the next day (including Saturday and Sunday). The on-call BMS should be informed (contact via the switchboard) if the sample is taken out-of-hours.


Faeces: Stool samples are not routinely tested in the Cytology Laboratory and are submitted by paediatric consultants only for the investigation of faecal fat. Please use 25 ml tall, sterile, blue capped universal container.

 

Fine Needle Aspirations and Breast Cyst Aspirates: Fine needle aspiration is performed on palpable and impalpable lesions. The most common sites for palpable lesions are breast, thyroid, soft tissues and lymph nodes. Impalpable lesions need to be identified by some form of imaging device. Cytological specimens will preferably be presented as direct smears (2 air dried preparations) as well as cell suspensions from needle washings in cytospin collection fluid, which is available from the Cytology Laboratory. Any FNA samples suspecting Lymphoma should have a second pass into Saline for Flow Cytometry (cells are unstable in this solution so samples should be hand delivered to Immunology on Level 6).Breast cyst aspirates may be sent as fluid and/or direct (air dried) smears. Please use 25 ml tall, sterile, white capped universal container.


Gastrointestinal Tract Specimens: Specimens from the gastrointestinal tract include indirect scrapes from oral lesions, as well as oesophageal and gastric brush samples and washings. Brush specimens may be spread directly onto a slide and/or the head of the brush may be detached and placed in cytospin collection fluid for transportation. Please ensure that direct smears taken for the investigation of candida infection are fixed as air dried preparations are unsuitable for this type of test. Please use 25 ml tall, sterile, white capped universal container.


Nipple Discharge: Nipple discharge is routinely received as two direct air-dried smears.
 

Serous Fluids (Pleural fluid, peritoneal fluid, pericardial fluid, ovarian cyst fluid): Serous fluids may be received as the result of direct taps/aspirations of effusions from pleural, peritoneal and pericardial cavities. The optimum amount is 20-25ml, less than that may compromise cell content but, on the other hand, large volumes of fluid may not improve the cell yield and create unnecessary preparation problems in the laboratory. Serous fluid samples should be dispatched without delay to the laboratory for processing. Peritoneal washings and ovarian cyst aspirates may also be sent for cytological investigation. Please use 25 ml tall, sterile, white capped universal container.

 

Sputum Specimens: Sputum samples are of limited value in the diagnosis of lung cancer. Correct collection is essential to ensure the sample originates from the lower respiratory tract. It is advisable not to send sputum samples prior to referral of the patient to a respiratory physician as cytology and biopsy specimens collected at flexible bronchoscopy have greater diagnostic sensitivity. Sputum samples should be collected on three consecutive days. Early morning expectorate is preferred, to eliminate contamination. The sputum should be from a deep cough, not a salivary ‘spit’. Please use wide necked container adding an equal volume of cytospin collection fluid.


Synovial fluids: Synovial fluid samples for the examination of crystals are not tested in the Cytology laboratory – please send to Microbiology. Only samples suspicious of cellular abnormalities are to be sent for cytological investigation. Please use 25ml tall, sterile, white capped universal container.


Urinary Tract Specimens: Urine samples should be collected on three consecutive days. It should not be the first morning sample nor a 24-hour collection since cells deteriorate quickly in urine. The first 20ml should be collected for cytological investigation. Urine samples should be dispatched without delay to the laboratory for processing. Please use 25 ml tall, sterile, white capped universal container.

 

CERVICAL CYTOLOGY


General Information

IMPORTANT NOTICE: RCHT (Royal Cornwall Hospital Trust, Truro) is now the central site for co-located cervical screening and hrHPV (High Risk Human Papilloma Virus) testing. PHNT catchment cases are now receipted, processed, stained and HPV-tested at RCHT. All courier routes currently remain unaffected with samples collected daily from surgeries in Blue Transport Bags. East Cornwall samples are transported directly to RCHT via existing Cornwall courier links.  Direct Referral arrangements will be instigated from RCHT.


RCHT enquiry line 01872 252550
Cytopathology
Royal Cornwall Hospital
Cornwall
TR1 3LJ


Contact details for key personnel:
Cathy Winn Cytology Manager
Cathy.winn@nhs.net or  cathy.winn@rcht.cornwall.nhs.uk


Clare Horne and Leonie Glinski, Senior Biomedical Scientists
Clare.horne@nhs.net or clare.horne@rcht.cornwall.nhs.uk
Leonie.glinski@nhs.net or leonie.glinski@rcht.cornwall.nhs.uk
            
LBC Kits (vials/brooms & blue Transport bags) can be ordered via email SBS-I.SWPSS@nhs.net
Kits are supplied in batches of 25 vials + 25 brushes. Additional LBC brushes may be supplied by your Lead PCT nurse.


Plymouth – tricia.smith2@nhs.net
Devon – Sandra.allwood@nhs.net
Cornwall Alison.Smith@CIOSPCT.cornwall.nhs.uk


Alternatively you can contact the supplier (Hologic) directly

  • Cervex brushes are supplied in boxes of 500 (20 re-sealable bags of 25). Contact UK Customer Services 01293 608500 or ukcustomerservice@hologic.com

Individual clear specimen bags are available from the PHNT Pathology Issue Store ext. 52418.


HMR cervical cytology request forms can be downloaded and printed from Open Exeter by accessing ‘patient details’ and then choosing ‘HMR101 A5 PDF’. The patient’s name, address, D.O.B, NHS number, previous cervical cytology history and GP’s address is populated onto the form. Please ensure all demographics are cross-checked with the patient at the time of their appointment.


Cervical sampling techniques/enquiries - contact RCHT enquiry line 01872 252550
 

Review Status

Reviewed September 2018 
This page will be updated December 2018

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