Laboratory & Pathology: Specimen Fixation and Collection

1.) Label two slides with two patient identifiers, the site of the aspiration and what number pass it is.

2.) Release a small drop of specimen from the syringe onto one of the slides. If possible, place the drop in the same general area as seen in the picture.

3.) Hold the slide with the specimen in your left hand and hold the other slide in your right. Flip the slide without specimen on it over. See picture.

4.) Gently place the slide in your right hand over the slide with the specimen. This allows the front of both slides to have an even amount of specimen dispersed amongst them.

5.) Quickly and gently pull the slides apart. Excessive force or pressure can damage cell quality. See picture.

6.) Place one slide in a cardboard slide folder to air dry.

7.) Place the remaining slide in a slide holder containing 95% alcohol.

Note: It does not matter which slide is air dried and which slide is alcohol fixed. The important thing is to prevent air drying to the slide that is going to be alcohol fixed. Get it into the holder as soon as possible.

When ordering a specimen in the computer please be sure to select the correct specimen type or else it cannot be processed.

Surgical Pathology: A specimen is ordered as a "surgical pathology" specimen when a core biopsy has been obtained.Even if slides are made and a cytojar is used along with the core biopsy, it is still ordered as a surgical pathology. Examples of surgical pathology specimens include lung, liver, and GI biopsies collected in formalin, with a needle wash in a cytojar and smears made.

Cytology: A specimen is ordered as a "cytology" when no core biopsy has been obtained. This is when the aspirate is used to make cytology smears and placed in the cytojar ONLY. Examples of cytology specimens include fine needle aspirations of thyroid, pancreas, cysts etc.

If you have any questions regarding proper ordering and a cytotech/pathologist is not present please feel free to call ext 41193 or 73016  for clarification.

Proper fixation is essential when it comes to analyzing cytology specimens. If a specimen is not collected appropriately, the diagnosis is compromised. The goal of the laboratory is to provide quality patient care and by following these tips we can decrease the number of "indeterminant" diagnoses.

Body fluids (CSF, pleural effusion, peritoneal effusion, urine, cyst fluid etc.)

It is important that the specimens be sent to the laboratory as soon after collection as possible. In some cases it is not possible to get the specimen down to the lab immediately, but there are other things that can be done to preserve cellular detail.

If a biohazard fridge is available, refrigerate the specimen until delivering it to the lab.

If cytolyt solution is available add an equal amount of cytolyt solution to the specimen. Ex. 50mL urine add 50 mL of cytolyt solution.

If pre-filled cytojars are available they can also be used.

**If cytolyt is added please write "cytolyt" or "cytolyt added" to the container, as processing these specimens differs from fresh specimens.

If a specimen is being split amongst various departments it is safer not to add cytolyt because this can inhibit testing in certain instruments in other areas of the laboratory. Inquire with the other laboratory departments if they can process specimens that are fixed with cytolyt solution.

Fine needle aspirations/ Core biopsies (thyroid, lymph node, breast, cysts,etc)

Particularly for thyroid FNAs, on-site rapid assessment is recommended. Having a cytotechnologist or pathologist there during the procedure ensures that an adequate amount of material is collected. This keeps the patient from having to repeat a procedure if the initial FNA was non diagnostic. If you are interested in on site rapid assessment please contact me.

If performing a FNA without rapid assessment assistance here are some recommendations:

If a biopsy is collected it is placed in 10% neutral buffered formalin. If one site is being biopsied, then multiple cores can go in a single jar of formalin. If multiple sites are being biopsied, each site needs its own individual jar. ex- head of pancreas mass: three cores are taken they can all go into the same formalin jar. If there are two lung nodules being biopsied (ex RLL and LUL) the cores from the RLL nodule are to be placed in one formalin jar and the cores from the LUL nodule are placed in another formalin jar. All jars need to be labeled appropriately.

If possible, before placing the core in formalin gently drag it across a glass slide and allow it to air dry or place it in 95% alcohol. (whichever is easier)

If a FNA is being done and no core is obtained a drop of specimen is placed on a glass slide and it is smeared with another slide via the direct smear method. (See procedure on this page) This results in two slides containing specimen. One slide is allowed to air dry and the other is placed in a slide holder containing 95% alcohol. The rest of the specimen is put into a jar of cytolyt solution. As mentioned above, if one site is being aspirated multiple passes of specimen can be placed in the same cytolyt jar. If more than one site is being aspirated they must be collected separately. Keep this in mind with the slides you prepare and make sure you label properly to avoid confusion.

**More is not necessarily better when it comes to putting a drop of specimen on a slide. If there is too much specimen the smear appears thick and unreadable under the microscope. Ideally, you want to have a thin, even layer of specimen across the slide. This is another reason that rapid assessment is beneficial; so that poor preparation of the specimen does not render a non diagnostic result.