Cytology Gastro-Intestinal Tract 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.

AP008

• 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 Cytolet fixative. After collection, the fresh 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.

1. General Recommendations: A. As a rule, the preparation of patient and collection of gastric washings are laborious and tedious. We get excellent results with gastric washings obtained with the "water pick method". B. Adequate preparation of the patient is essential to obtain satisfactory specimens from the gastro-intestinal tract. (see preparation of patient for specific procedure) C. Cytologic procedures should be performed prior to barium examination. Otherwise, wait 24 hours before attempting a cytologic study, since barium obscures cytologic detail, thus precluding proper examination of the specimen. D. It is essential that the specimen be delivered to the Laboratory immediately. E. The only contraindication to esophageal washing, gastric lavage, and duodenal drainage is danger of bleeding from tube irritation. If you would pass a tube for gastric analysis, the procedures may be performed safely. 2. Esophageal washing  A. Preparation of patient 1. Patient should fast for 8 hours prior to procedure. 2. Clear fluids ad lib until 1 hour before procedure. B. Materials needed 1. #18 Levine tube in which additional perforations have been cut in the terminal 6 cm. 2. 100 ml syringe 3. 500 ml normal saline 4. 500 ml flask, packed in ice C. Technique 1. Determine the proper tube position (measure against x-ray film or use fluoroscopy) so that the proximal perforation of the tube lies 3 cm distal to the lesion. Mark the point of the incisor on the tube. 2. Pass the chilled, unlubricated, multi-holed, #18 Levine tube through the mouth. 3. Position tube as indicated above (proximal perforation 3 cm distal to the lesion). 4. Ask patient to swallow normal saline solution (NSS) while gently aspirating through the tube with syringe. 5. Place the fluid in a flask packed in ice. 6. Repeat until 250 ml of fluid has been aspirated. 7. Set specimen aside until completion of procedure. 3. Gastric Lavage and Duodenal Drainage A. Preparation of patient 1. Routine patients a. Soft supper b. Fasting thereafter until procedure is completed. c. Clear fluids ad lib until 1 hour before procedure. 2. Patients with retention and residue a. Liquid diet the day before procedure b. Pass Ewald tube or other suitable tube and empty stomach the evening before procedure. If necessary, wash with NSS solution to remove all residue. c. Fast thereafter until the procedure is completed. d. Overnight Wangensteen suction, if necessary. B. Technique 1. Pass chilled, unlubricated, multi-holed #18 Levine tube through mouth. Empty stomach. Discard specimen. 2. Pass 50 ml of papain-buffer under pressure. Aspirate fluid and repass under pressure several times. Empty stomach and place fluid in centrifuge tubes. 3. Repeat procedure with another 50 ml papain-buffer. 4. Pass 400 ml papain-buffer under pressure. 5. Ask patient to roll in bed. Aspirate and repass fluid under pressure with patient in various positions. (e.g., supine, lateral). 6. Set specimen aside until completion of procedure. 4. Colonic Lavage A. Preparation of Patient 1. Soft supper and laxative the night before the procedure. 2. Light breakfast (cup of coffee or glass of milk only) the morning of the procedure. 3. Multiple NSS enemas morning of procedure until returns are clear. Patient will tolerate larger enemas if the foot of the bed is raised on shock blocks. Try to start with at least 2500 ml remembering that the larger the enemas, the fewer the enemas required to cleanse. Ask patient to lie on their left side, back, and then right side for a few minutes before expelling each enema in order to cleanse the entire colon. 4. When the returns are clear, stop procedure and wait for one-half hour to one hour before starting the technique outlined below. B. Technique 1. Introduce proctoscope to 20 cm or as far as possible without difficulty. 2. Insert Ewald tube through the proctoscope and remove proctoscope. 3. Allow 700 - 800 ml of NSS to flow through the tube under gravity. Clamp the tube. 4. Place proctoscope table horizontally. 5. Ask patient to lie on their left side and massage fluid up descending colon. 6. Ask patient to lie on their back and massage fluid along transverse colon. 7. Ask patient to lie on their right side and massage fluid down ascending colon. 8. Ask patient to lie on their back and massage abdomen, balloting fluid in cecum and in areas of greatest suspicion. 9. Fluid is collected and put aside. 10. Repeat procedure with another 700 - 800 ml of NSS. 11. Set specimens aside until completion of procedure. 5. After Completion of Procedure A. Immediately upon completion of procedure, bring the properly labeled specimen (patient's name and site of origin) and completed requisition forms to the Laboratory