Specimen Handling Procedures
To ensure accurate and timely results, 4path, Ltd. provides the following links to proper specimen handling instructions:
- Surgical Pathology
- Specimen Requiring Special Handling
- Cytology Specimens
- Physican Information Sheets
SURGICAL PATHOLOGY
Specimen Labeling
ALL specimens must be properly labeled with the following information:
Patient First and Last Name
Date of Birth
Source of Specimen
Date specimen was obtained
Specimen Request Form
ALL specimens must have a specimen request form which includes:
1. Patient Identification Data
2. Pertinent History (include any relevant descriptions of lesion/tissue)
3. Location/Source of Specimen
4. Time and date of procedure.
5. Insurance Information
Routine Surgical Pathology Specimens
Place all specimens in a properly labeled container with sufficient amount of formalin to COMPLETELY cover the specimen. (Exceptions are lymph nodes for possible lymphoma, muscle biopsies for myopathies/neuropathies and products of conception requiring chromosome analysis) Ideal amount of fixative should be 5-10 times the size/amount of tissue. Be sure to use sufficient size of container for larger specimens. Secure lid tightly. Specimens may be refrigerated, but do NOT freeze.
Please use formalin obtained from 4path.. This is specially formulated formalin to optimize histologic morphology and is NOT the same formalin that may be obtained from other sources. If you do not have 4path formalin, you may use routine formalin from other sources, however we are happy to provide our special formulated formalin for your use. Clients may request these supplies by sending an email to supplies@4path.com
SPECIMENS REQUIRING SPECIAL HANDLING
Lymph Nodes for suspected lymphoma
Please contact 4path for instructions BEFORE performing biopsy for instructions.
In general, lymph nodes should be submitted intact when possible, wrapped in a gauze pad that has been soaked in saline and squeezed damp. Lymph nodes should be transported immediately to 4path and ideally in the morning or early afternoon. This is so ensure that a suitable sample of tissue can be sent fresh for flow cytometric analysis, an often crucial adjunct in the diagnosis of lymphomas and leukemias. Longer delays in transporting fresh tissue to the flow cytometry lab means increased loss of viable cells for analysis and may limit diagnostic ability. Excessive delay in processing can significantly limit or eliminate the ability to make a diagnosis of lymphoma.
After hours, have laboratory contact pathologist on call for instruction (Click here for co
Lymph nodes for suspected lymphoma are best handled during normal working hours, carefully coordinated with 4path. This is necessary to ensure optimal handling of the specimen to maximize the amount of diagnostic information obtained from the tissue sample.
Muscle, Nerve or Kidney biopsies
These specimens are forwarded by 4path to a CAP certified laboratory which specializes in these specimens. Contact 4path BEFORE performing biopsies to ensure proper handling.
CYTOLOGY SPECIMENS
Routine Cytology Specimens
GYN cytology
- 4path currently does not perform GYN cytology on site, however specimens which are received will be forwarded to our affiliate CAP certified laboratory for analysis and a report will be provided from that facility.
THINPREP(TM) PAP TEST
- One PreservCyt solution vial containing the patient’s cervical specimen.
- Vial must be labeled with the patient’s first and last name.
- Complete cytology requisition including patient’s date of birth, last menstrual period (LMP), and any pertinent clinical history.
- Once in PreservCyt, the cells are preserved for approximately 3 weeks at 4 –37 degrees Celsius (39 – 98.6 degrees Fahrenheit).
Collection Materials
Endocervical Brush/Plastic Spatula (obtain from 4path or supplied by physician office)
PreservCyt Solution vial (obtain from 4path)
Collection Procedure (Endocervical Brush/Spatula Method)
1. Obtain an adequate sampling from the ectocervix using a plastic spatula.
2. Rinse the spatula as quickly as possible into the PreservCyt Solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.
3. 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. Slowly rotate ¼ to ½ turn in one direction. DO NOT OVER-ROTATE.
4. Rinse the brush as quickly as possible in the PreservCyt Solution by rotating the device in the solution 10 times while pushing again the vial wall. Swirl the brush vigorously to further release material. Discard the brush.
5. Tighten the cap so that the torque line on the cap passes the torque line on the vial.
6. Record the patient’s first and last name on the vial. Record the patient information and medical history on the cytology requisition form.
7. Place the vial and requisition in a specimen bag for transport to the laboratory.
HPV TESTING
- Specimen is a sample of the cervical/vaginal epithelium collected in a ThinPrep PreservCyt vial with a minimum volume of 4cc remaining of the original specimen.
- Specimen is not older than 20 days.
- The ordering physician requested reflexive HPV DNA testing and the current pap test is reported as Epithelial Cell Abnormality—Atypical Squamous Cells,
or
The ordering physician requested HPV DNA testing be performed in addition to the Pap test (i.e. DNA with Pap™).
CONVENTIONAL PAP SMEAR (NOT RECOMMENDED)
- One smear fixed with a commercially-prepared fixative or immersion in 95% ethanol for at least 15 minutes
- Glass slide labeled with the patient’s first and last name (preferably in pencil).
- Patient age or date of birth, menstrual status and history of abnormal pap tests or biopsies should be included on the requisition or addendum.
Collection Procedure.... Conventional Pap smear
1. Label the glass slide with the patient’s first and last name in pencil.
2. Expose the cervix using a speculum. Obtain a circumferential sample of the entire squamocolumnar junction by turning the Ayre’s spatula or cytobrush 360 degrees.
3. Using the wooden spatula, spread the specimen on a glass slide in a uniform monolayer fashion down the length of the slide.
4. Air drying starts to occur within 10 seconds of spreading the sample and can limit the specimen adequacy. Therefore fix the smear immediately by spraying the slide with a commercially-prepared fixative or immersing in a coplin jar of 95% alcohol for at least 15 minutes.
TZANCK SMEAR (for viral changes can be GYN or Non-GYN specimen)
- One fixed smear.
- Smear(s) is fixed with a spray fixative or by immersion in 95% ethanol.
- Label slide(s) with the patient's first and last name in pencil.
- Indicate site of smear on requisition.
Non GYN cytology
Fluids
URINE
- Acceptable specimens include: 25 ml or more of a second morning, voided urine. You may add equal volume of CytoLyt Solution, ethanol, or methanol to the specimen. If a preservative solution is not added, refrigerate specimen immediately until delivery of specimen to laboratory. Specimen collection containers with alcohol fixative are available from the laboratory.
- or Urine collected from a catheter
- Three specimens collected on three consecutive days is recommended.
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