Cytopathology

The Cytology department processes approximately 5000 diagnostic cytology samples per annum. It is part of the Pathology Department which in turn is part of the Central Clinical Services directorate.

Contact numbers

Cytopathology contact numbers are included in the Cellular Pathology contacts - click here.

Opening hours

Monday to Friday, 8.00am to 5pm.

Diagnostic cytology requests

Specimen containers

120 mL Uricyte kit containing 12 mL of preservative for urine cytology, 500 mL bottles containing EDTA for effusions, and 60 mL Sterilin container with metal lid for semen samples are available from the pathology store, ext. 64407.

Specimen request forms/ clinical information

A request form must accompany all specimens. Guidance on completing the request form can be found under general information on this website.

In order to ensure that the correct tests are performed the user must provide clear, sufficient and relevant clinical information. This information will help in the interpretation of the specimen and may include:

• Symptoms
• Underlying conditions
• Previous history of neoplasia/pathological conditions
• Recent infections

From July 2024 systems will be introduced in ICE to limit inappropriate repeat testing according to the Royal College of Pathologists guidelines (G147 National Minimum Retesting Intervals in Pathology, March 2021).

Specimens

All specimens must be clearly labelled with three patient identification points that correspond to the same identification points on the request form.

Prepared slides that are to be processed within the laboratory must be labelled with pencil as ink is removed by solvents used during specimen preparation.

Please be advised that air-dried preparations should not be performed on patients that are identified as ‘danger of infection e.g. ?TB, ?HIV.

Urgent specimens

Examinations offered by the laboratory

Fine needle aspirates (FNA)	The material obtained should be gently spread onto frosted end glass slides and rapidly air dried.  The slides must be clearly labelled in pencil with the patient’s name and date of birth and the site of aspiration. Slides must be completely dry before they are put into transport boxes. If fluid is aspirated this can be put in a blood bottle containing EDTA (pink top blood bottle).
Respiratory tract	Sputum, bronchial washings/lavages The whole specimen should be sent in a wide mouthed, screw-capped container or trap and should reach the laboratory the same day. Sputum specimens should be three early morning sputums taken on successive days before breakfast to avoid contamination with food or toothpaste.
	Nasal, pharyngeal swabs, buccal smears and bronchial brushings Bronchial brushings and swabs/buccal smears should be smeared gently onto frosted end glass slides and fixed immediately with cytology fixative. Allow 10 minutes before putting the slide in the transport box. The slides must be clearly labelled in pencil with the patient’s name and date of birth.
Gastrointestinal tract	Washings and lavage specimens The whole specimen should be sent in a wide mouthed, screw capped container and should reach the laboratory the same day.
	Endoscopic brushings Brushings should be smeared gently onto frosted end glass slides and fixed immediately with cytology fixative.  Allow 10 minutes before putting the slide in the transport box. The slides must be clearly labelled in pencil with the patient’s name and date of birth.
Effusions	Effusions consist of pericardial, pleural, ascitic or peritoneal fluids. Specimens should be collected in 500ml bottles labelled “FOR CYTOLOGY OF EFFUSIONS”. These bottles contain an anticoagulant (EDTA) to prevent clotting.
Urine	Types of suitable samples include: voided, catheter, bladder washings and ileal loop urine. Specimens are collected in 120 mL Uricyte kits containing 12 mL of preservative. The bottle contains fixative (alcohol and glacial acetic acid). Complete voided specimens are required. Midstream urine is not suitable for cytology as cells are often passed at the beginning and at the end of voiding. Early morning urine is also unsuitable because it contains degenerate cells, causing difficulty in interpretation. Urine Sample for Cytology Investigations- Patient Instruction Sheet (LIA-CYT-UPIS, revision 2, active 5.4.2023)
Joint fluids	Synovial specimens should be received in sterile pots.  Send an aliquot fresh to the Cytopathology department in an anticoagulant-free container.
Cerebrospinal fluid (CSF)	The CSF should be collected in a sterile universal container without fixative (plastic is preferable as some cells adhere to glass). CSF samples must be sent to the department immediately after being taken as they deteriorate rapidly, any delay may result in them being non-diagnostic. CSF samples should not be taken after 3pm to allow for transport and preparation time. In order to ensure successful cytological diagnosis and subsequent triage a sample volume of 3 mL+ should be collected where possible. If flow cytometry is required please send a separate sample to Blood Sciences.

EBUS clinics and BMS assistance at FNA clinics

The Cytology department also have a consultant led service which provides on-site provisional diagnosis at EBUS clinics and BMS assistance at a wide range of FNA clinics, including adequacy assessment at head and neck clinics.

Please note the BMS staff do not perform the aspirations however the support of a BMS is recommended for optimal sample preparation.

Turnaround times

The diagnostic cytology department uses the Royal College of Pathologists (RCPath) guidelines for turnaround times (TAT). That is, 80% of cases are to be reported within seven calendar days of the sample being taken whilst 90% are to be reported within ten calendar days.

TAT relates to the final local report and excludes cases sent for external opinion and those that require immunocytochemistry or molecular analysis.

Specimen packaging

1. Packaging must be of good quality, strong enough to withstand the shocks and loadings normally encountered during transport. Individual primary receptacles and the secondary packages should be tightly closed and sealed with tape or other means to prevent leakage (“Ziplock”® bags would meet this requirement).

2. The packaging shall consist of at least three components. The outer packaging must be rigid.

1. a primary receptacle
2. a secondary packaging, and
3. an outer packaging

of which either the secondary or the outer packaging shall be rigid.

Road vehicles which collect from surgeries, clinics etc. are often fitted with box(es) into which the collected item is placed. Such boxes may be considered to constitute the outer packaging. Collected items must consist of a primary receptacle and a secondary packaging.

3. Primary receptacles shall be packed in secondary packaging in such a way that, under normal conditions of transport, they cannot break, be punctured or leak their contents into the secondary packaging. Secondary packaging shall be secured in outer packaging with suitable cushioning material.

Transportation of samples

Samples are delivered directly to the laboratory by portering staff or sent using the courier system. Please ensure that all lids are secured prior to transportation of the specimen, as leaking specimens may not be processed.

Specimen transportation

Sample packs arrive at the laboratories via several routes from service users.

Internally they are delivered by clinical staff/ward staff/porters/healthcare assistants in person. It is expected that sample packs will be delivered promptly to maintain their integrity for testing. If users are delivering samples in batches they must ensure all samples within the batch are able to withstand any batching delay.

Externally, sample packs will also be delivered by the courier service from external sources such as GP surgeries and clinics in batches also. Again the sample packs must remain viable throughout the batching time. If viability could be impacted external users are required to liaise with the laboratory or the designated courier themselves to have bespoke collections.

Certain specimens must be delivered to the laboratory as soon as possible:

• CSF samples (these should not be taken after 3pm, to allow for transport and preparation time).
• Fresh tissue specimens including those for frozen sectioning.

The acceptance and rejection of samples

If either the request form or specimen is incorrectly labelled then the sample may be returned or rejected. A Datix incident will be completed on all unsatisfactory labelled specimens.

Key factors known to affect performance

In order for the laboratory to perform the correct tests and provide the appropriate results it is important for requesting clinicians to be aware of the factors which can affect test performance and the interpretation of results. For example:

• Samples place in formalin fixative
• Wrong specimen container used e.g. effusion bottle for a urine specimen
• Inappropriate specimen container used e.g. ‘normal’ sterile container used for urine collection instead of Uricyte container thus resulting in bacterial overgrowth
• Delay in transportation, e.g. with CSF samples
• Inadequate volume of specimen
• Poor quality specimens
• Insufficient supply of clinical details.

If in any doubt, please contact the laboratory for advice.

Availability of clinical advice

Clinical advice from Consultant Pathologist is available. This can be obtained by telephoning the department during normal working hours.