Quality in cytology

The Cytopathology laboratory is committed to providing a high quality service and uses an integrated system of internal quality control to ensure the accuracy and reliability of test results.  The laboratory is currently accredited to UKAS Medical Laboratories accreditation ISO 15189:2012.

External Quality Assurance

All staff involved in the reporting of non-gynaecological cytology participate in the North West Region Non Gynaecological Cytology EQA scheme run by the Countess of Chester Hospital.

The department participates in UKNEQAS Non-gynaecological Diagnostic Cytology Technical EQA Scheme.

All unfixed Cytology cell samples will begin to degenerate from the moment of collection, thereby rendering them difficult to interpret and potentially unsuitable for diagnostic purposes.  In the interests of the patient, it is advisable that they be transported to the laboratory for processing as soon as is possible to minimise autolysis and promote accurate and timely reporting.To facillitate this, specimens must arrive in the laboratory correctly labelled and packaged and accompanied by an appropriate request form completed with the minimum data set and all relevant patient and clinical details.

SPUTUM CYTOLOGY

Early morning deep cough specimens resulting from overnight accumulation of secretions yield the best diagnostic results.  A single specimen taken on each of three consecutive days should be sent to the laboratory for analysis as soon as it is collected to maximise diagnostic accuracy.  The patient must be carefully instructed not to spit without a deep cough as saliva is of no diagnostic value. The specimen sent is randomly sampled and 5-10ml is regarded as the minimal optimal volume requirement for this test.

FLUID CYTOLOGY

Examples of these include,  pleural or ascitic effusions, peritoneal washings, breast cyst fluid, hydrocele fluid and ovarian cyst fluid. These should be sent fresh, directly to the laboratory or kept refrigerated until transported.  A maximum of 25 mls of the sample should be delivered to the laboratory in a sterile universal container for processing. Do not send drainage bags as transport and disposal of large quantities of unfixed fluid present health and safety risks.

URINARY TRACT CYTOLOGY

A freshly voided or catheter sample  should be collected into  250ml urine pots and sent directly to the department.  If this is impossible refrigerate and transport at the first available opportunity.  The second full voided specimen of the day is optimal for accurate cytological assessment.  Avoid sending the first specimen of the day i.e. an early morning urine, as this has the disadvantage of marked cellular degeneration.  Urine bottles are available from the Cytology department. Please indicate if it is a catheter sample.

BRUSH CYTOLOGY

Examples of these include , gastric, rectal, oesophageal, and bronchial brushings.

Using clean slides, clearly label the frosted  end in pencil, with patient name and PID as a minimum. Spread sample by rolling the brush along the slide. Preparations must be fixed immediately with an alcohol based fixative to preserve the material. Immediate fixation is essential to promote and enhance staining and subsequent accuracy of reporting. 

Please check the expiry date of the spray fixative that we provide before use and if you require more, please contact - This email address is being protected from spambots. You need JavaScript enabled to view it.

Please write on the slide if the samplemslide is air-dried or fixed as this helps to ensure the correct sample preparation is performed

Brushes used for brush washing liquid based cytology preparation must be thoroughly rinsed in  10 ml of CytoLyt as soon after collection as possible.  Any delay in this process may compromise both the quality and quantity of diagnostic material shed from the sampler into the vial and result in potentially suboptimal preparations upon which the diagnosis may be based.

Place slides in a slide carrier (ensure they are separated)  for transportation

FINE NEEDLE ASPIRATION  CYTOLOGY (FNAC)

Examples of these include aspirates from, breast, lymph node, thyroid, and salivary gland .;

Slides prepared in the clinic for FNAC may either be air-dried and/or alcohol fixed and will be stained in the laboratory accordingly.

It is imperative that specimens are spread thin and evenly and are either wet fixed and or dry fixed immediately, to promote optimal fixation, staining and therefore accuracy of reporting.

(Please ensure you check the expiry date of the spray fixative we provide before use and if you require more - contact This email address is being protected from spambots. You need JavaScript enabled to view it.).

Direct Slide Preparation Technique:

CEREBROSPINAL FLUID

These specimens are particularly delicate and require immediate preparation to prevent cellular degeneration.  They must be sent directly to the laboratory in a sterile universal container clearly labelled with the patient's name and PID.  If sending after 16:00 please inform the laboratory at the earliest opportunity prior to despatch to ensure staff availability for timely preparation. Sample volume obtained from the patient for this test is usually less than 1ml hence all material sent is usually processed.

BRONCHOALVEOLAR LAVAGE CYTOLOGY (BAL)

(for differential cell count)

BAL specimens must be in as near a natural state as possible for accuracy of reporting.  They must be collected into a sterile, labelled universal container and packed on crushed ice and transported immediately to the laboratory for preparation to prevent cellular degeneration.  Sample volume obtained from the patient for this test is variable however 30 ml is the expected average.

BAL samples for differential cell count must be sent to the laboratory packed in crushed ice, sealed and delivered to Pathology by a porter immediately after sample collection. - this is essential to ensure minimal cell degeneration.

Please notify the laboratory prior to BAL sample collection to inform them of approximate time of arrival. For optimal results BAL samples should be collected and received at the laboratory for processing on the same day. This ensures that the slide preparation can be completed as soon as possible to minimise the risk of cellular degeneration on the differential cell count results.

Collection of BAL samples during the early part of the working day is encouraged to permit transport time to the laboratory and time for processing and preparation of the slides the same day of sample collection.

 If the sample is expected to arrive after 16:00 pm the department must be notified with an approximate time of arrival to ensure that there is staff availability.

Please be advised that the laboratory opening hours are 8:30 – 17:30. In the event that a BAL sample is collected and sent to the laboratory outside of these hours the sample will be refrigerated until the laboratory next re-opens. There is a risk that during this time degeneration of cells can occur which can have an impact on results.

SYNOVIAL FLUID CYTOLOGY (for crystals)

These specimens must be sent in a sterile white capped universal container. Please ensure the request form is clearly labelled "for crystals". 5ml is an optimal  sample  volume for processing and reporting.

Miscellaneous  Non-Gynae Samples

Please contact the Cytology laboratory for advice regarding unususal samples.

Factors affecting performance

Please ensure that samples arrive in the laboratory as soon as possible after collection as unfixed cells degenerate quickly 

Please ensure that unfixed material spread onto glass slides following FNA procedures are air dried rapidly to facillitate staining

Please ensure that cytology brush specimens spread on glass slides are fixed immediately with spray fixative to prevent cellular autolysis

Please ensure that material left over from cytology brush samples are immersed in fixative solution (PreservCyt) immediately following procedures.

Please inform the laboratory of any urgent samples to facillitate reporting times

All samples should be sent to the laboratory as quickly as possible but if not practical, may be refrigerated until transportation can be effected. Samples from the GHH/ SOL sites, may be refrigerated in central reception and sent the following day on the first available shuttle if no other viable option is available.

• Breast and respiratory samples requiring URGENT attention to meet with Multi-disciplinary Meeting deadlines are prioritised and sent on the next available shuttle of the day.
• Broncho-alveolar samples sent on ice for differential white cell count and cerebrospinal fluids are also sent on the next available shuttle, to minimise the effects of cellular degeneration. For optimal results BAL samples should be collected and received at the laboratory for processing on the same day. This ensures that the slide preparation can be completed as soon as possible to minimise the risk of cellular degeneration on the differential cell count results.

Non-gynae Specimen Labelling and Request Form

Completing the non-gynaecological request form

Each sample must be accompanied by the appropriate Non-Gynae Cytopathology request form complete with the following essential patient details:

• Full Name
• PID or NHS Number or Date of Birth
• Location or destination for report
• Consultant or GP
• Specimen type
• Test required
• Date and time collected.  This is especially important for CSF and BAL specimens as delays may compromise the reliability of the test result.

Non-Gynae request forms are available from the Cytology department or electronically via ICE requesting. All sections of the paper copy request form should be fully and legibly completed in ball point pen.

Labelling of non-gynaecological specimens

Specimens should be collected in an appropriate transport vessel which is intact undamaged and with the lid firmly fitted to prevent spillage or leakage and must be clearly labelled with:

• Full Name of Patient
• PID, NHS Number or Date of Birth (whichever is given on form)
• Specimen type
• Date and time collected which is essential for CSF and BAL specimens as time factors affect the test result.

Any unlabelled samples which can easily be repeated, such as urines, will be rejected on receipt into the laboratory. In cases of unlabelled or mislabelled samples from an invasive procedure, the responsible clinician will be notified as soon as possible and requested to identify and label the sample in the laboratory before it can be processed.

In the event of multiple specimens from one site, each sample pot must be labelled clearly so they are readily distinguished from one another. In the case of samples from different sites, a separate request form for each specimen site is required.

Glass slides must be labelled using PENCIL with:

• Full Name of Patient
• PID, NHS Number or Date of Birth (whichever is given on form)
• Air-dried or alcohol-fixed.  This is particularly important to ensure slides undergo the correct processing method aiding accurate microscopic assessment. 

Please note: ink or marker pen labelling of glass slides will be lost during processing rendering the slides unlabelled.

For urgent specimens, including Cerebrospinal Fluid and Bronchoalveolar Lavage, please notify the laboratory prior to dispatch to ensure staff availability for timely preparation and reporting.

·         Cytology Laboratory 0121 424 1191.  Opening hours: 08.30 – 17.30.

Specific Instructions for the Packaging of Non-gynae Specimens

• After labelling, samples should be placed in an individual clear plastic transport bag and sealed using incorporated fastener. DO NOT secure with pins, staples, etc.
• Please place the request form in the integral side pocket (not in the bag with the specimen) to avoid contamination in the event of a spillage. 
• Place multiple individual sample bags in large orange transport bags and seal ready for transport to the laboratory. These bags are available from Pathology Stores Tel: 0121 424 2461 and must be used where possible.  This will ensure samples are delivered directly to the Cytology laboratory, thereby avoiding unnecessary delays.
• Sealing the bags will minimise the risk of loss of samples during transport to the laboratory and protect courier from any spillages that may occur.
• Bronchoalveolar Lavagesamples must be sent to the laboratory on ice - this is essential to ensure minimal cell degeneration. They should be packed in ice, sealed and delivered to Pathology by a porter. Please inform the lab of their expected arrival time, to ensure staff are available to process the sample.

Non-Gynae reporting times

Non-gynaecological cytology specimens are usually reported within 5 working days of receipt unless special or immunocytological stains are required which may cause a delay.

Non-gynaecological specimens are kept by the department for 7 days following receipt, after which they are considered unsuitable for diagnosis. Although requests for further examinations are possible, this will only be carried out following discussions with a Consultant Pathologist. 

Out of hours, a Consultant Pathologist may be contacted via UHB HGS (Heartlands, Good Hope, Solihull) switchboard.

Interpretation of results

Should you require an interpretation of results please contact the department and request to speak to the reporting pathologist.

Interpretation of results can only be discussed with the reporting pathologist

Key Factors affecting the performance of the examination or interpretation of results

·        Ensure that samples are sent to the laboratory as soon as possible after collection as unfixed cells degenerate quickly.

·        Send non-gynae cytology specimens to the laboratory using the ORANGE non-gynae cytology transport bags to ensure that once received at Laboratory Medicine Central Reception they are forwarded to the correct department.

·        Ensure that cellular material prepared onto glass slides following FNA procedures undergoes either air-drying or alcohol-fixation as appropriate without delay to facilitate optimal staining by the laboratory, thereby assisting in accurate microscopic assessment.  Label slides as air-died or alcohol-fixed to ensure slides undergo the correct processing method.

·        Immerse any residual sample material from cytology fine needle aspiration or brush samples in CytoLyt immediately if they are to be transferred to the laboratory for processing.  Universal Containers of CytoLyt are available from Cytology (Tel: 0121 424 1191).

·        Inform the laboratory of any urgent samples to facilitate timely reporting.

·        Due to the fragile nature of some specimens such as CSF and BAL samples please contact the laboratory prior to taking specimens to ensure that the department can be available to process these specimens.