Breast Discharge

NAME OF PROCEDURE:

Breast Discharge

TEST CODE:

NGYN

CPT CODE:

88104 – Cytopathology, fluids, washings, or brushings, except cervical or vaginal; smears with interpretation.

APPLIES TO:

Breast Discharge, Breast Secretion, Breast Smear, Nipple Discharge, Nipple Secretion, Nipple Smear.

SPECIAL INSTRUCTIONS:

• Information regarding type of specimen, admitting diagnosis and pertinent clinical history (i.e., age, clinical impression, past diagnosis, radiographic findings, and history of radiation/chemotherapy or malignancy) is essential to interpretation and should be noted on the requisition.
• Infectious diseases suspected should be indicated.
• Clinical evidence of immunosuppression should be indicated.
• Special handling requirements (isolation) should be clearly noted on the requisition.
• If other studies are required, submit to appropriate laboratory separately.

SPECIMEN:

• Smear(s) (spray-fixed or  fixed in 95% alcohol) from expressed breast discharge.
• Nipple/Breast discharge is a useful method of diagnosing benign and malignant conditions in the breast.

CONTAINER:

• Slide container with 95% alcohol.
• Cardboard slide holder(s).
• Label container (s) with a minimum of two patient identifiers.

COLLECTION TECHNIQUE:

 

1.    Complete the requisition entirely. 2.    Pre-label slides with name and sample site. 3.    Pre-label alcohol fixative container with the patient’s name and sample site. 4.    Gently express pea size discharge from nipple. NOTE: If no secretion appears, do not manipulate further. 5.    Place discharge on pre-labeled glass slide by smearing in an even, thin layer over the length of the glass slide. NOTE:  Repeat procedure to collect more specimen from nipple on other slides, if needed. 6.    Fix immediately by immersing slide(s) in 95% alcohol container or by applying a cytology spray fixative. ·         Immediately spray slide(s) with cytology spray fixative, holding container 6 – 12 inches from slide. Lightly mist entire slide with fixative. ·         Gently place slide(s) into labeled cardboard slide holder(s) and allow to dry completely before closing and securing for transport. ·         Secure cardboard slide holder(s) with tape or rubber bands to prevent opening during transport. 7.    If nipple discharge is more than a drop, make additional smear(s) by using the “pull apart” method. ·         Place a second slide gently on top of the first slide containing the fluid/discharge. ·         Allow the weight of the slide to spread the secretion between the slides and quickly but gently pull the slides apart. ·         Immediately fix both slides using spray fixative or by immersing in 95% alcohol. 8.    Note additional pertinent information gathered during the procedure (e.g., bloody/clear fluid, right/left nipple, etc.) on the requisition. 9.    Place all labeled containers into a sealable Biohazard specimen bag and include the completed requisition in the outside pocket of the specimen bag. Specimen is maintained at room temperature. 10. Send to laboratory immediately or place in designated drop-off area for courier pick-up and delivery,

REQUEST FORM:

Anatomical Pathology Requisition

• Complete patient information section.
• Complete the Non-Gynecologic section thoroughly.

CAUSES FOR REJECTION:

• Incomplete requisition.
• Specimen container(s) or slides not properly labeled.
• Improperly fixed specimen/air-drying artifact.
• Slide(s) irreparably

LIMITATIONS

• Allowing smears to dry before they are fixed will render them unsatisfactory for cytologic evaluation.

METHODOLOGY:

Smear(s) are examined microscopically using the Pap stain method.

ADDITIONAL INFORMATION:

Information is also available on the SEPA website under Resources – Directory of Services.

Please call laboratory if you have questions.