Non Gynae User Manual 2013 - Central Manchester University
Contents
1. assessment Find or contact us at CMFT The cytology department is located on the first floor of Clinical Sciences Building 2 All visitors should access the department via the reception area of Clinical Sciences Building 1 Please also contact us if you have any complaints or service improvement suggestions Address Cytology Department First Floor Clinical Sciences Building 2 Manchester Royal Infirmary Oxford Road Manchester M13 9WL Email cyto patholo cmft nhs uk Telephone Enquiries Telephone Fax General 0161 276 5115 8817 0161 276 5113 Non gynaecological results 0161 276 5115 5116 6727 Booking an FNA at CMFT 0161 276 5111 8817 or Bleep 07659545074 Advice on non gynaecological sample collection 0161 276 5111 5115 Dr M Desai Head of Service amp Director of 0161 276 5099 mina desai cmft nhs uk the North West Cytology Training Centre Dr D N Rana Consultant Cytopathologist amp 0161 276 5108 durgesh rana cmft nhs uk Clinical Lead for Non gynaecological Cytology Dr M Holbrook Consultant Cytopathologist 0161 276 6475 miles holbrook cmft nhs uk Dr M Perera Consultant Cytopathologist 0161 276 5109 dona perera cmft nhs uk Dr S Thiryayi Consultant 0161 701 7570 sakinah thiryayi cmft nhs uk Histo cytopathologist Annette Lawton Medical Secretary 0161 276 5115 annette lawton cmft nhs uk Nicola Wood Medical Secretary 0161 276 5116 nicola wood cmft nhs uk Helen Wilson Medical Secretary 0161 276 62. 727 helen wilson2 cmift nhs uk Jennifer Bradburn Medical and North West 0161 276 8804 jennifer bradburn cmft nhs uk Cytology Training Centre Secretary Adanna Ehirim Chief Biomedical Scientist 0161 276 5119 adanna ehirim cmft nhs uk Daniel Smith Cellular Pathology Manager 0161 276 6138 daniel smith cmft nhs uk Find or contact us at the Christie Hos We are located in the Bereavement Suite at Christie Hospital and are available between the hours of 09 00 hrs to 12 30 hrs Monday to Friday except bank holidays One staff member is available for FNA services and answer queries relating to non gynaecological cytology only Telephone Enquiries Telephone General 0161 446 3643 Non gynaecological results See CMFT number above No results are issued at Christie Booking an FNA at Christie 0161 446 3643 Advice on non gynaecological sample collection 0161 446 3643 E mail cytolo christie nhs uk Specimen acceptance policy Each specimen must be accompanied by a completed and matching sample request form Please ensure all fields of request forms are completed See page 14 for instructions on filling out the non gynaecological request form A blank copy of same is available for download on page 15 Alternatively we can supply bulk forms on request All specimen containers must be clearly labelled with Patient s full name Date of Birth NHS amp or Hospital number Specimen type non gynaecological Clinical de
3. A i Manchester University Hospitals NHS NHS Foundation Trust Cytology Department Non gynaecological cytology service User Manual January 2013 Tent Table of contents About us Hours of opening Services available at CMFT Services provided to the Christie Hospital Find or contact us at CMFT Find or contact us at the Christie Hospital Specimen acceptance policy Current practice and research activity Collection of serous fluids Collection of cyst fluids Collection of respiratory tract samples Collection of urinary tract samples Collection of cerebrospinal fluid samples Collection of gastrointestinal brush samples 10 Fine needle aspirations 11 How to perform an FNA 12 Making spreads from an FNA 13 Completing the non gynaecological cytology request form 14 Download a non gynaecological cytology request form 15 O ON OOO BRWNNM ND P The cytology department of Central Manchester University Hospitals NHS Foundation Trust CMFT is one the largest unit of its kind in the country providing cervical screening using the SurePath Liquid Based Cytology System and a wide variety of non gynaecological cytology and synovial fluid analyses services Please see the Cervical Cytology and Synovial Fluid User Manuals for more information on those services Our non gynaecological cytology services include fine needle aspiration FNA as well as exfoliative cytology We also provide a non gynaecological service to The Christie Hospital NHS F
4. BUS FNA service in October 2012 A Consultant Cytopathologist is on site to provide preliminary diagnoses with technical assistance provided by a biomedical scientist This has proved extremely successful in terms of preliminary diagnosis specimen triage and reflux molecular testing e Best results are achieved with freshly obtained sputa following chest physiotherapy with an early morning sputum before the patient has eaten e Contamination with large amounts of saliva or food leads to inadequate specimens e Multiple specimens usually x 3 may be necessary but these should be sent on 3 separate days not all taken at the same time e Send in clean dry container with screw cap e f examination for eosinophils is required please indicate this on the request form Bronchial aspirates lavage wash trap and bronchoalveolar lavage samples Fresh specimen should be placed in a clean dry container and an equal volume of CytoRich Red preservative fluid immediately added for fixation The time of this fixation should be indicated on the label of the container If CytoRich Red preservative fluid is not available fresh specimen should be placed in clean dry container Delay in receipt unfixed samples can lead to deterioration of specimen If differential cell count is required DO NOT USE CytoRich Red preservative fluid Please send the sample unfixed DO NOT USE FORMALIN FIXATIVE Fresh Specimen F Specimen with an equal volume
5. DE LURt N B Incomplete forms will result in delay in the reporting of the specimen Visit our website www cmft nhs uk _ Comment Aae2 This is the treating consultant to whom the report must be sent _ Comment Aae3 Department of treating consultant Comment Aae4 It is essential that a complete history is given such as previous diagnoses and or duration of symptoms etc Comment Aae5 Radiologica 1 findings amp or clinical impression are extremely helpful to the cytologists Comment Aae6 Previous amp or current treatment regimes help avoid under and over diagnosis 1 Comment Aae7 Name and contact number of the clinician taking the sample is essential IIL IIT CMET off site non gynaecological cytology request form PATIENT S DETAILS AFFIX STICKER HERE SPECIMEN DETAILS PLEASE TICK Surname URINE BRONCHIAL Voided Brush Catheterised Lavage Wash Post instrumentation Trap Aspirate Ileal conduit Ureteric Urethral washing Forename Bronchoalveolar Lavage Please state site and side of BODY CAVITY lobe Pleural Fluid FNA TECHNIQUE Pericardial Fluid ee Ultrasound Guided Ascitic Fluid CT Guided Peritoneal Fluid Transbronchial i Peritoneal Washing CSF FNA SITE amp SIDE LURt Address Cyst Fluid Please state site aac NHS number Please state site Leia SS Consultant s department where report is to be sent D
6. ate taken _ CLINICAL INFORMATION HEAD AND NECK FNAs Please indicate and label site on diagram below Right as Left Diagnosis Previous Cytology Previous Histology Previous Treatment Chemo radiotherapy High Risk Yes Aspirating Clinician PLEASE PRINT Signature and date N B Incomplete forms will result in delay in the reporting of the specimen Visit our website www cmft nhs uk 15
7. ng in selected non small cell lung cancer cases Dual antibody staining for immunocytochemistry SA ee cae oe sample collection Serous fluid samples including peritoneal washings Please see specimen acceptance policy on page 4 Body cavity fluids pleural ascitic peritoneal fluid peritoneal washing pericardial e 50 100mls fluid should be sent in a clean dry container with screw cap Note no formalin or alcohol should be added to the sample as both of these can cause interference with adherence to slide and quality of staining e The fluid should be submitted as soon as possible to minimise cell deterioration so that cell preservation is not compromised Mr A N Other DOB 01 01 20XX Hosp num 101010 If there is a delay in delivering the sample to the laboratory ard the sample should be kept in a fridge at 4 C Note the sample should NOT be frozen Cyst fluid e Cyst fluid should be put into a clean dry container with screw cap e The sample should be sent as soon as possible in order to minimise cell deterioration However if there is a delay in the sample being delivered to the laboratory it should be kept in a fridge at 4 C Note the sample should NOT be frozen Respiratory tract samples Please see specimen acceptance policy on page 4 Transbronchial FNA see FNA section Endobronchial ultrasound FNA EBUS FNA We are please to announce that we started a consultant led E
8. of CytoRich Red preservative fluid Please note When the stock of CytoRich Red preservative fluid is running low or close to its expiry date please contact the cytology department on 276 5111 91 16 for replacement Bronchial bru sh samples Place brush into clean screw capped container with CytoRich Red preservative fluid Ensure brush is fully immersed in preservative The time of this fixation should be indicated on the label of the container DO NOT USE FORMALIN FIXATIVE Please note When the stock of CytoRich Red preservative fluid is running low or close to Its expiry date please contact the cytology department on 276 5111 5116 for replacement of stock Urinary tract samples Urine including voided catheter urethral washings and ileal conduit samples Collect urine in a clean dry container with a screw cap A 20ml to 50ml container is suitable An adequate urine sample is the second voided of the day preferably mid morning or random Please note The first sample voided in the morning is unsuitable for cytological analysis Urine can be collected from catheters as well as washings from the bladder or upper urinary tract The request form must state the method of collection If there is a delay in delivering the sample to the laboratory the urine sample should be kept in a fridge at 4 C Industrial Urine samples The preferred method for the collection of industrial urine samples is the same as above p
9. oundation Trust As of January 1 2013 our services have been expanded to incorporate Trafford General Hospital which is now part of CMFT The department is housed in a new building with state of the art facilities and is affiliated to the North West Cytology Training Centre which is situated on the ground floor of Clinical Sciences Building 2 The department is fully CPA accredited We are fully committed to maintaining this accreditation by an established quality management system and standards determined by the Royal College of Pathologists together with scheduled clinical and quality audits and national guidelines Hours of openino The department is open from 08 00 hrs 17 00 hrs Monday to Friday except bank holidays Non gynaecological samples should be received in the department by 16 45 hrs Services available at CMFT 1 Exfoliative cytology 2 Biomedical scientist BMS assistance at radiological and ad hoc FNA clinics 3 BMS assistance and on site specimen adequacy assessment at dedicated Head and Neck clinics including thyroid usually Tuesday mornings and alternate Thursday afternoons 4 On site consultant led provisional diagnoses adequacy assessment of endobronchial ultrasound EBUS FNA samples Services provided to the Christie Hospital e Non gynaecological Cytology 1 Exfoliative cytology 2 Fine needle aspiration cytology including BMS assistance in slide preparation and on site specimen adequacy
10. ove place a clean slide spreader above the drop and spread gently but swiftly Leave to air dry Step 2 Rinse the remaining material from the needle into the CytoRich Red preservative fluid by repeated aspiration and expelling of the said CytoRich Red preservative fluid Step 3 Label container containing CytoRich Red preservative fluid according to specimen acceptance policy page 4 and use a pencil to label slide Step 4 Complete request form see page 13 package sample and send to Cytology Department Clinical Sciences Building 2 13 Surname Forename Address Sex a DOB Hospital NHS number Ward Dept Diagnosis IIL IIT CMET off site non gynaecological cytology request form PATIENT S DETAILS AFFIX STICKER HERE SPECIMEN DETAILS PLEASE TICK Sree clear yt e site aspirat or topography of sample URINE Voided Catheterised Post instrumentation Ileal conduit Ureteric Urethral washing BODY CAVITY Pleural Fluid Pericardial Fluid Ascitic Fluid Peritoneal Fluid Peritoneal Washing Cyst Fluid Peat Please state site NHS Please state site Previous Cytology Previous Histology Previous Treatment Chemo radiotherapy High Risk 14 Yes BRONCHIAL Brush Lavage Wash Trap Aspirate Bronchoalveolar Lavage Please state site and side of lobe FNA TECHNIQUE Ultrasound Guided CT Guided Transbronchial FNA SITE amp SI
11. pecimen adequacy assessment at Head and Neck clinics including thyroid every Tuesday mornings and alternate Thursday afternoons The staff in the laboratory will be pleased to advise and assist on any aspect of sample collection please contact the department at e Cytology Department Monday to Friday between 08 00 hrs and 17 00 hrs on 0161 276 5111 5115 5116 We may also be contacted by bleep on 07659 545074 e Please note calls must be received by 16 15 hrs for FNA attendance e Inthe absence of Cytology staff assistance a guide to performing aspirations and making spreads is given on pages 12 and 13 respectively e Christie hospital FNA clinics Monday to Friday 09 00 hrs to 12 30 hrs on 0161 446 3643 It is recommended that the support of a BMS be utilised for optimal sample preparation e Patients presenting with palpable lesions in clinics ENT maxillofacial outpatients and wards e Deep seated lesions sampled by radiologically guided techniques Ultra Sound CT e Endoscopic and transbronchial guided specimens For all Radiology Endoscopy EUS FNAs Respiratory Medicine EBUS FNAs and Head amp Neck ENT and Maxillofacial departments please book with the Cytology Department in advance Equipment required for a fine needle aspiration e Standard disposable 21 25 gauge needles A 25 gauge orange needle is suitable for most lesions e Disposable 5 10 ml plastic syringe e Clean container with tight lid preferably unive
12. referably in 25ml Universal tube Please contact the cytology department in advance when sending large number of samples Cerebrospinal fluid CSF Please see specimen acceptance policy on page 4 A clean dry container with screw cap should be used CSF samples are liable to degenerate rapidly and as such must be prepared immediately Please contact the laboratory to inform staff of imminent arrival of a CSF sample and leave a bleep or contact number Latest processing time for samples is 15 30 hrs Mon Fri CSF samples must be received at least half an hour before this time If out of hours sampling is unavoidable storing the sample in refrigerator at 4 C may help preserve cells for up to 24 hours 10 Gastrointestinal Tract Brushings including bile duct Place brush into clean screw capped container with CytoRich Red preservative fluid Ensure brush is fully immersed in preservative The time of this fixation should be indicated on the label of the container DO NOT USE FORMALIN FIXATIVE Please note When the stock of CytoRich Red preservative fluid is running low or close to its expiry date please contact the cytology department on 276 5111 5116 for replacement of stock Fine needle aspiration cytology samples We provide biomedical scientist BMS assistance at FNA clinics to prepare direct spreads and needle rinses Please note the BMS staff do not perform the aspirations We do provide BMS on site rapid s
13. rsal containing CytoRich Red preservative fluid e Standard microscopic glass slides onto which aspirate is to be smeared Completion of request form and sample container Please see specimen acceptance policy on page 4 11 Part A How to perform a fine needle aspiration Disinfect skin using pre packed alcohol swabs Before insertion of needle wipe away any excess ultrasound jelly with tissue paper if U S guided Perform the aspiration according to the instructions A G A Position needle within target tissue B Pull plunger to apply negative pressure C Move needle back and forth inside target D Release negative pressure while needle remains in target tissue E Withdraw needle F Detach needle and draw air into syringe G Push a drop of sample onto microscopy slide Figure taken from Fine Needle Aspiration 2005 4 Edition S Oreell G F Sterrett and D Whittaker Elsevier Churchill Livingstone 12 Part B Making spreads from fine needle aspirations The ideal FNA sample is prepared as follows e Even monolayer spreads onto glass slides for air dried direct smears e Needle to be rinsed in CytoRich Red preservative fluid if available or sterile saline e 2passes are recommended for each case e If Tuberculosis is suspected please also send an aspirate to microbiology in a sterile container Step 1 Having expelled a small drop of the aspirate onto a glass slide step G ab
14. tails Turn around time e Non gynaecological cytology reports are printed and sent out daily addressed to the consultant or GP who requested the test e Reports of any malignancy are faxed e To discuss the cytology report with the Consultant Cytopathologist contact the department between 08 00 hrs and 17 00 hrs on 0161 276 5115 5116 E a a Urgent specimens e Urgent specimens will be reported at least verbally within three 3 working days of receipt by the laboratory Please provide a contact details on request card e This may only be a provisional report pending further ancillary tests e It is recommended that the requesting clinician discuss such specimens with the Cytopathologist between 08 00 hrs and 17 00 hrs on 0161 276 5115 5116 In all cases the clinician should telephone the laboratory in advance and provide a contact name and phone or bleep number Routine specimens e Routine specimens will be reported within five 5 working days of receipt This may vary depending on the specimen type and if additional clinical information or ancillary tests are required e g immunocytochemistry Current practice and research activity e We currently use a mixture of direct spreads cytospins and SurePath Liquid Based Cytology LBC technology in our sample preparation e Our research activities include Penile brush cytology Oro pharyngeal brush cytology High risk HPV testing in head and neck cancers Molecular testi
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