- Ideal sampling date is two weeks after the first day of the LMP
- Discourage sampling during normal menses.
- Avoid use of vaginal medication, vaginal contraceptives, or douches for 48 hours prior to examination.
- Using a lead pencil, write the patient’s name and a second unique identifier on the frosted end of the slide (unlabeled slides cannot be accepted)
- Scrape cervix with spatula provided and smear on glass slide.
- Insert the cytobrush into endocervical canal until the bristles are barely visible; turn 90˚-180˚ and remove immediately. Smear/roll the sample onto the glass slide. (Brush not recommended for use during pregnancy).
- Immediately apply fixative. The fixation step is one of the most important considerations in specimen preparation.
- Obtain… …an adequate sampling from the ectocervix using a plastic spatula
- Rinse… …the spatula as quickly as possible into the PreservCyt Solution vial by swirling the spatula vigorously in the vial 10 times. Retain the spatula in PreservCyt vial.
- Obtain… …an adequate sampling from the endocervix using an endocervical brush device. Insert the brush into the cervix until only the bottom-most fibers are exposed. Slow rotate ¼ to ½ turn in one direction. DO NOT OVER-ROTATE.
- Rinse… …the brush as quickly as possible in the PreservCyt Solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall. Swirl the brush and spatula vigorously and scrape bristles with spatula to further release material. Discard the brush and spatula.
- Tighten… …the cap so that the torque line on the cap passes the torque line on the vial.
- Record… …the patient’s name and a 2nd unique identifier on the vial…the patient information and medical history on the cytology requisition form
- Place… …the vial and requisition in a specimen bag for transport to the laboratory
- Smear
- Write patient’s name and another unique identifier in pencil on frosted end of slide.
- Submit 1-5 slides of material from any source that can be evaluated cytologically.
- Fix the first smear immediately with spray fixative and allow the second smear to air dry without fixative. Repeat this process for additional sets of smears. Allow all slides to dry fully before packaging slides for transport.
- Submit in appropriate slide container.
- Include appropriate clinical information on properly filled out requisition form.
- Fluid
- Submit fluid in a leak-proof container.
- The container must be labeled with the patient’s name, a 2nd unique identifier, and the source of the fluid.
- Refrigerate until courier pick-up.
- Submit a completed requisition, including appropriate clinical information.
- Breast Secretion (Nipple Secretion)
- Drops of fluid from the nipple are smeared directly on clean glass slides and fixed immediately with spray fixative. Submit multiple slides whenever possible. **If a Fat Stain (Oil-Red-O) is needed, leave one glass slide to air dry and mark frosted end with an “A”.
- Bronchial Brushing
- Roll brush(s) over clean, dry slides. Fix immediately with spray fixative. The brush(s) may be placed in 50-ml tube containing at least 30 mls Cytolyt. Submit slides and/or liquid together on one requisition.
- Bronchial Washing
- Submit liquid in a in a leak-proof container or in a 50-ml tube with 30 mls Cytolyt.
- Effusions
- Put specimens in a leak-proof container. You may add a portion of the specimen to a 50-ml tube containing Cytolyt.
- Esophageal Brushing
- Roll brush(s) over clean, dry slides. Fix immediately with spray fixative. The brush(s) may be placed in a 50-ml tube containing 30 mls Cytolyt. Submit slide(s) and/or liquid with one requisition.
- Esophageal Washing
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Put specimens in a leak-proof container. You may submit liquid in a 50-ml tube with 30 mls Cytolyt.
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- A. Solid Mass
- Label 8-10 glass slides with the patient’s name and another unique identifier on the frosted end prior to starting.
- If local anesthesia is used, insert the needle adjacent to, but not into the lesion.
- Attach a 21, 22, or 23-gauge needle to a 20-ml syringe and prefill with air if desired
- Insert syringe into a fine needle aspiration syringe holder.
- Insert needle into lesion.
- While applying negative pressure, move needle in short stabbing motions while changing the angle of direction into the lesion.
- Release negative pressure, then remove needle from the mass. Specimen should not be drawn up into barrel of the syringe. Pressure should be released as fluid appears in the needle hub.
- Carefully eject one drop of specimen onto the slide.
- Use another slide to smear the aspirated material.
- Fix one slide immediately using spray fixative and allow one to air dry. Label fixed side with “F” and one air dried slide with “A”.
- This procedure should be repeated with an attempt to sample different areas of the mass each time.
- If blood, fluid, or cellular material in excess is obtained with a needle pass, it should be expressed into a prefilled 50-ml centrifuge tube containing 30 mls of Cytolyt fixative. The needle and syringe should be rinsed with this same solution. Submit the liquid specimen with the slides using one request form.
- Clinical information is required for the pathologist to render a diagnosis. Please indicate on the request form the specific site, clinical diagnosis, whether the lesion is solid or cystic and gross appearance of the aspirate if applicable.
- B. Cystic Mass – Steps 1-8 are the same as the above procedure.
- Express the fluid into a prefilled 50 ml centrifuge tube containing 30 mls of Cytolyt fixative. The needle and syringe should be rinsed with this same solution.
- Clinical information is required for the pathologist to render a diagnosis. Please indicate on the request form the specific site, clinical diagnosis, whether the lesion is solid or cystic and gross appearance of the aspirate if applicable.
- Gastric Brushing
- Roll brush(s) over clean, dry slide(s). Fix immediately with spray fixative.
- The brush(s) may be placed into a 50-ml tube containing at least 30 mls Cytolyt fixative.
- Submit slides and/or liquid on one requisition.
- Paracentesis
- Put specimen in a leak-proof container. You may place a portion of the specimen into a 50-ml tube containing 30 mls Cytolyt fixative.
- Skin (Viral) lesions (Tzank Smear)
- Remove crust or dome from lesion. Scrape ulceration with a curette. Spread material on a clean glass slide. If multiple slides are obtained, submit some air dried and some with spray fixative.
- Sputum
- Submit early morning deep-cough specimen prior to any food ingestion. Have patient rinse mouth with plain water. Collect sputum specimens on 3-5 consecutive mornings. Do not pool specimens.
- Urine
- Collect specimen in a leak-proof container. Place in the refrigerator until courier pick-up.
"Conventional" PAP Test
Patient Preparation
Proper patient preparation encompasses the following:
Conventional Cervical (GYN) Pap Smear
Proper technique for the collection and preparation of cytological specimens by the clinician is just as important as the experience of the cytotechnologists and pathologists who evaluate them. There are various sites in the female genital tract that may be considered as a source for cytologic specimens. However, for adequate study of the female genital tract for malignancy, we suggest a well-collected and properly preserved Pap smear taken from the ectocervix and the endocervix.
ThinPrep Pap Smears (GYN)
ThinPrep Pap Test Quick Reference Guide Endocervical Brush/Spatula Protocol
*ThinPrep Pap must be processed within 6 weeks post collection when retained between 15-30°C.
*No brush, broom or spatula should be submitted in vial.
Non-Gyn Specimen Collection
See below for site-specific instructions.
Fine Needle Aspiration Biopsy
There are several variations of the Fine Needle Aspiration Biopsy technique. We recommend prior training. *On-site specimen adequacy is available, in most instances, upon a prescheduled request.
