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Gyn Pap Smear
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Leiomyoma
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Radiation Changes
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1. Prepared Slides:
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a.
Spray fix with commercially available spray fixative (e.g., "Pap"
smears, Fine Needle Aspirations (FNAs); or
b. Immediately immerse slides in 95% ethyl alcohol (e.g., direct sputum
smears and FNAs); and/ or
c. Air dry slides (e.g., FNAs; consult with the pathologist before
using this option). |
Precaution: It is very important
that prepared slides are labeled with the patient's name and origin of
the specimen for proper identification in the laboratory.
| 2. Fluid Specimens: |
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a. Mix the specimen with an equal volume of 50% ethyl alcohol;
or
b. Submit the specimen fresh and unfixed only when the specimen
can be delivered to the laboratory within 2-3 hours.
Important: Fresh specimens should be refrigerated to slow
cell degeneration and bacterial growth.
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Precaution: It is very important
that specimen containers be labeled with the patient's name and origin
of the specimen for proper identification in the laboratory.
DO NOT SUBMIT SYRINGES WITH NEEDLES
ATTACHED
Note: All specimens submitted to
Cytopathology must be accompanied by a Cytopathology Examination Form
accompanied with the "patient's identification" including name,
date of birth, and hospital medical record number. The following information
must be provided: name and telephone number of the submitting physician,
date the specimen was collected, anatomic site of the specimen, previous/
current therapy and essential history and clinical information. In addition,
for gynecological specimens: date and normalcy of last menstrual period,
duration of current pregnancy, menopausal status, hormonal administration
and pertinent clinical history must be included.
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1. Ascites - See "Body Cavity Fluids"
2. Aspiration Cytopathology - See " Fine Needle Aspirates"
(FNA)
3. Body Cavity Fluids - [peritoneal (ascites), pleural,
pericardial, cyst fluids, joint fluid, miscellaneous fluids]: 5-10
units of heparin per 1cc of fluid should be in the syringe as the
fluid is withdrawn to prevent clotting.
4. Breast - see "Fine Needle Aspirates" (FNA)
5. Bronchial Washings - It is mandatory that all of the
material collected be placed in alcohol fixative without delay unless
immediate processing is available. Specimens should be mixed with
an equal volume of 50% ethyl alcohol. Fresh unfixed specimens should
be refrigerated at 4°C.
6. Bronchial Brushing - Prepare thin smears on clear (non
frosted) glass slides that have been labeled with the patient's
identifying information and immediately immerse in 95% ethyl
alcohol or spray fix (see above). Air drying of the slides should
be avoided.
7. Cerebral Spinal Fluids - The volume of the sample has
considerable bearing on diagnostic accuracy: the larger the sample,
the better the results. If several samples are obtained, the second
or the third should be used for cytopathology. Fresh, unfixed specimens
should be refrigerated and submitted to the laboratory immediately.
The addition of an equal amount of 50% ethyl alcohol to the sample
is recommended if a delay in delivery and/ or processing is anticipated.
If there is a clinical history or suspicion of hematopoietic disease,
an unfixed sample is preferable and the clinician should inform
the supervisory personnel of the cytopathology laboratory.
8. Cervical Smears - See " PAP Smears
9. Colonic - See " Gastrointestinal Specimens"
10. Cystoscopic or Catheterized Urine - see "Urine"
11. Endocervical Smears - see PAP Smears.
12. Fine Needle Aspirates (FNA) - For superficial
masses, the attending pathologist is available to perform the aspirates.
Arrangements can be made by calling the Cytopathology Service at
612-347-3084. Clinicians who wish to learn the proper aspiration
techniques for superficial masses or organs may contact Dr. Ricardo
Bardales (beeper 612-336-0217 or 612-347-5669 for personalized instruction.
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a. Solid lesions: prepare direct smears from needle (see
below) and immerse them immediately into 95% ethyl alcohol
or spray fix. In certain clinical settings it may be preferable
to air dry some or all of the slides prepared. After the slides
have been prepared, rinse the needle and syringe with 95% ethyl
alcohol and submit the fluid with the slides for evaluation.
b. Cystic lesions and nipple discharges: use the method
described below under "Handling of Fluids Obtained for Aspiration".
The Cytopathology Services offers assistance for radiographically
directed aspirates (CT scan, fluoroscopy, ultrasound) of deep organs.
Contact Cytopathology Services, 612-347-3084 or Dr. R. Bardales
(beeper 612-336-0297).
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| 13. Gastrointestinal
-(e.g., colonic, duodenal, esophageal, gastric specimens) |
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a. Brushings: prepare thin smears on labeled clear (non frosted)
glass slides and immediately spray fix or immerse in 95%
ethyl alcohol. Air drying of the slides is inappropriate for this
specimen type.
b. Washings: mix the volume with an equal volume of 50% ethyl alcohol
unless immediate processing is available.
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14. Lymph Node Aspirate - See FNA. Discuss with the pathologist
before the aspirate is performed to determine which slide preparation
is best for the specific clinical setting in question.
Note: Immunophenotypic studies by flow cytometry and/ or
immunoperoxidase can be performed on FNA material. Consult the Cytopathology
Service for further assistance.
15. PAP Smears - (gynecological cervical, endocervical and
vaginal smears). It is important that smears be made from material
collected from the squamo-columnar junction. Two smears, one from
the exocervix and one of the endocervical canal are preferred. Prepare
thin smears on labeled clear (non-frosted) glass slides and immediately
spray them with a commercial spray fixative or immerse in 95% ethyl
alcohol before air drying occurs.
It is important that the slides are
properly labeled with the patient's name and site of origin for
proper specimen identification in the laboratory. Slides that are
not labeled with the patient's name will be rejected for evaluation.
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a. Hormonal Evaluation
- gently obtain material from the upper third of the lateral vaginal
wall. Prepare slides and fix as noted above. The slide should
be identified as to origin. The LMP must be submitted. |
| Note:
A maturation index cannot be given in the presence of endocervical
elements (endocervical cells, squamous metaplasia), an inflammatory
process, CIN (dysplasia), or carcinoma. |
Precaution: Do not use lubricants
in examining the patient before the specimen is taken or on any instruments
used to obtain the specimen. It is not recommended that specimens be taken
within 24 hours after a douche, or 6-8 weeks after biopsy, curettage,
cone biopsy or cauterization. Do not take specimens before 6 weeks post
partum. Not indicating the above conditions on the request slip may
impede correct interpretation of the specimen. Please provide all
pertinent clinical information on the request slip including the date
of the last menstrual period, age, use of IUD, or hormonal therapy.
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16. Liquid-based PAP Smear: Using the plastic spatula from
the collection kit, rotate in the ectocervix. Rinse spatula quickly
into PreservCyt vial by swirling vigorously. Insert endocervical
brush in to the cervix until only the bottom most fibers are exposed.
Slowly rotate one 1/2 turn in one direction. Do not over rotate.
Rinse brush quickly in the same PreservCyt solution by rotating
the brush 10 times while pushing against the vial wall. Swirl brush
vigorously to further release material. Tighten the cap onto the
vial. Label with patients first and last names.
17. Sputum - Three day early morning pooled deep cough specimens
or three separate daily early morning deep cough specimens are acceptable.
For assistance call the Cytopathology Service 612-347-3084.
18. Salivary Glands - See FNA
19. Thyroid - See FNA
20. Urine - Multiple voided urine specimens are invaluable
in assessing the status of the lower urinary tract. Catheterized
urine is acceptable. For cytological evaluation of the bladder three
morning samples of urine each of about 50 to 100 mL, obtained on
consecutive days are recommended.
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C.
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These directions are intended for FNA of superficial masses, such
as those occurring in the breast, lymph nodes, thyroid, subcutaneous
tissues, and prostate. These masses are localized primarily by palpation.
Equipment:
1. Alcohol swabs, sterile gauze
2. 10cc slip tip syringes (not "Luer Lock")
3. 1 1/2 inch long 25 gauge needles
4. Syringe holder, 10cc (Cameco or equivalent)
5. Glass slides with frosted end (not totally frosted)
6. 95% alcohol
7. Coplin jars (or equivalent)
FNA consists of four coordinated steps:
1. Palpation
2. Aspiration
3. Smear preparation
4. Microscopy
In order to have an accurate interpretation, palpation, aspiration
and smear preparation must be efficiently performed. These skills
can be sharpened only by person to person instruction, and feedback
from the pathologist.
1. Palpation
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a. The target is localized and evaluated by palpating it between
the tips of the index and middle fingers.
b. The target area is cleaned with an alcohol swab without removing
the fingers.
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| 2. Aspiration |
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(Needle is attached to syringe and placed in syringe holder)
a. Needle is inserted through skin rapidly, then carefully advanced
into lesion.
b. Plunger is pulled back and held there.
c. Needle syringe combination is moved in a straight line back and
forth motion 15 to 20 times.
d. Plunger is released before withdrawing needle.
e. Needle is withdrawn. Pressure applied with gauze over puncture
site.
f. Needle is removed from syringe, plunger is pulled back to load
syringe with air, and needle is reconnected.
g. Plunger is pressed down, expressing material from needle onto
glass slide.
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| 3. Smear Preparation |
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a. The glass slide containing the specimen is held with one hand;
the smearing slide is held with the other.
b. The flat surfaces of the two slides are held parallel and touched
together gently; the long axis of each slide is then moved along
the specimen slide, making the smear.
d. The specimen slide is immersed immediately into 95% alcohol.
e. Smearing slide may be fixed in alcohol or air dried. The specimen
may also be divided into two or more parts with special techniques.
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1. Prepare two or more slides by placing a small
drop of fluid on each slide and making smears as described above.
2. Unless the fluid can be processed immediately, it is mixed with
an equal volume of a suitable fixative and submitted to the laboratory
(a good fixative is 50% ethanol). |
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