Specimen submission guidelines
The following guidelines are intended to assist you in preparing optimal specimens for cytologic
evaluation. If you have questions about specimen submission, call the cytology laboratory between
8 a.m. and 5 p.m., Monday-Friday.

General tips
An adequate clinical history is often vital, both for diagnostic purposes and to assure proper laboratory
workup (special stains for organisms, flow cytometry or immunostains for lymph node aspirates in
suspected lymphoma etc.). Since not all tests can be performed in the case of every specimen, appropriate
history enables the cytopathologist to direct a more efficient and rapid workup.

If multiple sites are sampled, label each individually if a site-specific diagnosis is needed for clinical
management.


Fine needle aspiration (FNA)
FNAs can be performed on a superficial (palpable) mass or on a deep-seated lesion under radiographic
guidance. For a superficial FNA:

1) A thin (most commonly a 23 or 25 gauge) needle is attached to a 10 or 20 cc syringe.
2) The needle is inserted into the mass. Negative pressure is introduced by pulling back on the syringe
     plunger.
3) The needle is rapidly moved back and forth in small excursions within the mass while suction is
     maintained. As the needle is nearly (but not completely) withdrawn from the mass, the angle of entry
     may be slightly altered so that a different region of the mass is sampled. Disaggregation of cells is
     accomplished by the cutting action of the needle.
4) The plunger of the syringe is released, after which the needle is withdrawn.
5) The aspirated material is ejected onto a glass slide and a second slide used to spread the material
     in a thin, even film.
6) The prepared slide is immediately fixed in 95% ethanol or sprayed with a suitable fixative. A delay in
     fixation of even a few seconds may cause drying artifact which distorts the cells sufficiently to interfere
     with an accurate diagnosis. For some lesions (i.e. enlarged lymph nodes or thyroid nodules) it is helpful
     to submit both fixed smears and one or more unfixed slides for later staining by the laboratory.
7) The needle may be rinsed in Saccomanno fixative or a cell culture medium such as RPMI, which is sent
     to the laboratory so that other preparations such as cytospins and cell blocks can be made.
8) If liquid material is aspirated from cystic lesions, it can be submitted in a sterile container to the cytology
     laboratory. If such material contains abundant blood, it can be heparinized by adding a small amount of
     heparin mixed in normal saline.

FNAs can be performed by a clinician or a cytopathologist. The advantages of a pathologist doing the
procedure are that a rapid evaluation can be rendered regarding adequacy of the aspirated material and
need for repeating the procedure (usually a minimum of 2-3 passes with the needle are necessary to assure
an adequately cellular sample). In addition, the pathologist can direct the distribution of aspirated material
for other tests, such as microbiologic culture, flow cytometry and electron microscopy, as indicated by
preliminary evaluation of the smears. To schedule an outpatient FNA (performed in the ENT Clinic on the
1st floor of Hermann Hospital) call the cytology laboratory at (713) 704-6464; specify that the pathologist
is to perform the aspiration.


Tzanck smears
Select and unroof an intact vesicle. Scrape the base of the lesion with a scalpel blade and spread the
material in a thin film on a glass slide, immediately immersing the slide in 95% ethanol or spraying it
with an appropriate cytologic fixative (air-drying causes cellular enlargement/distortion which may make
it impossible to reliably diagnose viral-induced nuclear changes. Slides should be clearly labeled with
the patient's name.


           
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