Cytotlogy Sputum Specimens

Submit specimen with a Pathology requisition.
Label specimen container with patient's complete first and last name, date of birth, date and time of collection, and specimen source.

AP011

• Send the specimen to the Laboratory in an appropriate closed, labeled container with the appropriate fixative for the tests requested. If you are unsure of the proper fixative, contact the Histology laboratory at extension 3405 for clarification. • Specimen source If submitting multiple specimens, the label must match the requisition as A, B, C, D, etc. Label specimen container with patient's complete first and last name, date of birth, date and time of collection, and specimen source. Optimally, the specimens should be submitted to the laboratory fresh or placed in Cytolyt fixative. After collection, the unfixed material must be sent to the laboratory as soon as possible. Cellular autolysis begins immediately after the sample is collected (e.g., urine or bloody serous effusion). Collection of each type of specimen is presented here for correct procedure. Diagnostic cytology is based on three basic sampling techniques: (1) collection of exfoliated cells, (2) collection of cells removed by brushing or similar abrasive techniques, and (3) aspiration biopsy or removal of cells from non-surface bearing tissues by means of a needle, with or without a syringe. If there is an unavoidable delay encountered in the delivery of the specimens (e.g., weekend, etc.), specimens must be refrigerated or preserved with Cytolyt fixative. Specimens can be refrigerated for a week or more and still be satisfactory. DO NOT freeze the specimens. Freezing will fracture cells.

When a pulmonary lesion is suspected, a complete sputum series should be done. The complete sputum series consists of an early morning sputum specimen every day for 5 days. The complete sputum series increases the detection of primary bronchogenic carcinoma from 45% (one specimen) to 95% (five specimens). DO NOT submit 24-hour sputum collections. Submit fresh specimens directly to CPA Laboratory area. All sputums should have accompanying requisitions. 1. Containers: A. Wide-mouth plastic cup with screw lid. B. These are available in the Laboratory. 2. Sputum Induction A. The Respiratory Therapy Department uses their equipment to induce and collect specimens for cytologic study. B. A more satisfactory specimen may be expected and a better rate of cancer detection should follow the use of sputum induction in cases where patient has difficulty producing a satisfactory specimen. C. Specimen and completed requisition forms should be sent to the Laboratory. 3. Sputum Technique A. Give the patient properly labeled plastic cups. Tell the patient not to use it until morning. B. Instruct the patient to cough deeply upon awakening (first thing in the morning before breakfast or brushing teeth), and expectorate all sputum into the container. Encourage the patient to expectorate SPUTUM and not saliva. D. Take the specimen and completed requisition form to the Laboratory as soon as possible. E. Repeat procedure every morning for a minimum of 3 days and preferably for 5 days. 4. Post-Bronchoscopy Technique This is the most valuable specimen, more valuable than a single sputum or bronchoscopy specimen. A. Give patient one plastic container mentioned above, before bronchoscope is withdrawn. B. Ask patient to cough deeply and expectorate all sputum into container for 1 to 2 hours. C. Take specimen and completed requisition to the Laboratory. D. Continue the sputum series using Sputum Technique. E. For patients with bronchial obstruction, heavy inflammation, or previous inconclusive reports: (when there is a suspicious finding on chest x-ray and no malignancy is evident on cytologic examination, but there are changes consistent with an obstructive process). F. A repeat sputum series is recommended after adequate therapy (antibiotic, expectorant, and/or bronchodilator) when radiologic findings are inconclusive and cytologic study does not show evidence of malignancy but is consistent with obstructive process. 1. Administer therapy for 5 days. 2. On third day, commence sputum series as in Sputum Technique.