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Non-Gynecological Submission Guidelines

Fluids/Smears

Cytologic specimens should be submitted in a plastic graduated container for analysis by PSMG. A tightly closed urine container is sufficient for this purpose. Specimens may be submitted by physicians, podiatrists, qualified nurse practitioners, and osteopaths. Upon request, PSMG will provide Saccomanno fixative; a green, alcohol-based liquid (also referred to as "carbowax", which is one of its components).  This is used primarily for cyst fluids, urine, abdominal washes, FNA needle rinses, and respiratory fluid specimens (such as sputum, bronchial washings and bronchoalveolar lavage) unless a lipid stain is requested, in which case the specimen should be unfixed.  SDS (Safety Data Sheets) are available.

Body Cavity Fluids (ie. Pleural, Pericardial and Peritoneal) Do Not Fix
Volume Preferred: 100ml in a graduated plastic container (such as a urine container).
Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred). Place specimen in plastic biohazard bag and seal.  Place completed cytology requisition in the exterior pocket of the plastic bag.  Send to the hospital lab (if applicable) as soon as possible.  Refrigerate specimen in the hospital lab and send with the next available courier to the PSMG Cytology Department.
Other Fluids (Cyst, Common bile duct, Pancreatic duct) Fix
Mix specimen with equal volume of Saccomanno fixative.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).  Place completed cytology requisition in the exterior pocket of the plastic bag.  Submit specimen to the hospital lab (if applicable) and/or send with the next available courier to the PSMG Cytology Department.
CSF (Cerebrospinal Fluid) Do Not Fix
Minimum volume of 1mL (3mL – 10mL preferred) original container
In order to prevent cellular degeneration send cytology aliquot to hospital lab (if applicable) as soon as possible.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).  Place specimen in plastic biohazard bag and seal.  Place completed cytology requisition in the exterior pocket of the plastic bag.  Once in the hospital lab, refrigerate and send to the PSMG Cytology Department with the next available courier. Do not freeze specimen.

Sputum: Fix
Early morning, deep cough specimens are preferred. Instruct patient to rinse mouth with water prior to each collection.  Have patient cough deeply from diaphragm and collect sputum. Mix specimen with equal volume of Saccomanno fixative.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).  Submit specimen to the hospital lab in original collection container in a plastic biohazard bag. Place completed cytology requisition in the exterior pocket of the plastic bag.  Send with the next available courier to the PSMG Cytology Department.

Washings (Bronchial, peritoneal/pelvic, kidney) : Fix
Mix specimen with equal volume of Saccomanno fixative.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).  Submit specimen to the hospital lab in a plastic biohazard bag.  Place completed cytology requisition in the exterior pocket of the plastic bag.  Send with the next available courier to the PSMG Cytology Department.

Bronchoalveoloar Lavage: Fix (dependent upon stain request)
Refrigerate.  If requesting a lipid stain, do not add Saccomanno fixative.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).  Submit specimen to the hospital lab in a plastic biohazard bag.  Place completed cytology requisition in the exterior pocket of the plastic bag. Send with the next available courier to the PSMG Cytology Department.

Brushings (esophageal, bile duct, pancreatic duct, gastric, bronchial other) Fix
Prepare and fix slides promptly.  Label slides with patient’s name and specimen type (in pencil).  Rotate brush gently, but rapidly on clean glass slide.  Fix slide immediately with spray fixative.  Rinse the remaining material from brush or clip off the wire and place the entire brush in a container of Saccomanno fixative.  Submit to the hospital lab (if applicable).  Place completed cytology requisition in the exterior pocket of the plastic bag.  Send with the next available courier to the PSMG Cytology Department.

Urine (Voided, Catheterized, Ileal Conduits) / Bladder Washings Fix
Minimum specimen volume is 25 mL
First morning urine should be avoided due to possible overnight cellular degeneration. A “clean catch”/ midstream specimen for women is recommended to avoid vaginal cell contamination.  Hydrate the patient before collection. Mix entire specimen with equal volumes of Saccomanno fixative.  Label the specimen container with specimen source details:  voided, catheter, ileal, washing, and at least 2 patient identifiers (name and DOB preferred).  Place completed cytology requisition in the exterior pocket of the plastic bag.  If Saccomanno fixative is unavailable refrigerate specimen until pick up. Submit to the hospital lab (if applicable).  Send with the next available courier to the PSMG Cytology Department.

Cyst Fluid (Breast, Ovarian, Other) Fix
Mix specimen with equal volume of Saccomanno fixative.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).  Submit specimen to the hospital lab (if applicable) in a plastic biohazard bag.  Place completed cytology requisition in the exterior pocket of the plastic bag.  Send with the next available courier to the PSMG Cytology Department.

Breast or Nipple Secretions Fix
Gently strip subareolar area and nipple with thumb and forefinger.  When secretion occurs, allow a pea-sized drop to accumulate.  Touch a clean slide to the nipple and withdraw slide quickly.  Immediately spray slide with fixative.  Repeat procedure until all secretions from the breast are collected on two or more slides.  Label slides with the patient’s name (in pencil).  Place slides, when dry, in slide container with completed cytology requisition.  Send to the PSMG Cytology Department with the next available courier.

TZANCK / Viral / Herpes Preparation Fix
The Viral / Herpes / Tzanck Preparation is the scraping of a lesion or vesicle in order to determine possible viral origin.  Write patient’s name on the frosted end of 2 slides in pencil.
Slide One: Open a FRESH vesicle with a sterile blade, spatula or other appropriate instrument (you may also aspirate the lesion) touch the instrument to the labeled slide. Immediately spray fix with cytology (Pap) fixative.  Please DO NOT AIR DRY the slide.
Slide Two:  Scrape the vesicle and touch to the second slide. Do NOT smear.  Immediately spray fix with cytology (Pap) fixative.  Please DO NOT AIR DRY the slide.  Place slides, when dry, into slide container and plastic baggie. Place completed cytology requisition in the exterior pocket of the plastic bag.  Send to the Pathology Sciences Medical Group with the next available courier.

Miscellaneous Smears (Prostatic Massage, Skin Lesion, other) Fix
Label slides with patient’s name and the source of the smear in pencil.  Fix slides immediately with spray fixative.  Allow to dry and place slide in slide carrier.  Submit to the PSMG Cytology Department with the next available courier.

Fine Needle Aspiration Biopsy

FNA Performed by PSMG
Pathology Sciences has an onsite fine needle aspiration (FNA) facility.  Our pathologists can perform FNA on any palpable mass and process the specimens on site.   Simply call our office between 8am-5pm Monday through Friday to schedule your patient.

Submission of FNAs Procured Elsewhere
(Breast, Head + Neck, Lung, other)
Pathology Sciences can accept and process FNA specimens that you perform in your office. The slides should be labeled with the patient name and DOB (in pencil).  It is also very helpful if you indicate if the slides are air dried or fixed. Fixation is specimen dependent.  Telephone the Pathologist on call at 530-891-6244 for technical questions.  For general questions ask for the Cytology Department at the same number.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).   FNA needles should be rinsed in Saccomanno fixative, with the resultant liquid submitted in a tightly closed container. This closed container may be submitter to PSMG together with the FNA slides. (After rinsing, the FNA needle itself then can be properly disposed of at your clinic/hospital.)  If you do not regularly receive specimen pick-up service from us, contact us for pick-up. Please submit specimen with a PSMG “Pathology Examination Request,” or requisition form.  In addition to patient demographics, the form should include any clinical data which is relevant to the case.  Please remember to include the name(s) of the doctor or other professional medical services provider. FNA needle note:  Please do not send FNA needles to PSMG.

Anal Pap Smears

Anal Pap Smears Fix
The sample is collected with the patient in the lateral recumbent or dorsal lithotomy position.  A Dacron swab moistened with tap water is inserted blindly 5 to 6 cm into the anal canal past the anal verge and into the rectal vault.  The swab is rotated with firm lateral pressure and slowly withdrawn (1).  Place Dacron swab in SurePath vial, snap off handle and send swab + vial to PSMG. Clearly indicate “ANAL PAP” on requisition to distinguish it from GYN Pap specimen.  Label the specimen container with specimen source and at least 2 patient identifiers (name and DOB preferred).  Place completed cytology requisition in the exterior pocket of the plastic bag.  Send with the next available courier to the PSMG Cytology Department.

Reference: (1) Cibas, Edmund S., and Barbara S. Ducatman.  CYTOLOGY: Diagnostic Principles and Clinical Correlates, Third edition.Philadelphia: Saunders, 2009.

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