Sputum Cytology

NAME OF PROCEDURE

Sputum Cytology

TEST CODE

NGYN

CPT CODE

  • 88112 – Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal
  • 88305 – Level IV – Surgical pathology, gross and microscopic examination

APPLIES TO:

Pulmonary Series; Random Sputum, Sputum Cytology, Random Collection, Sputum Series.

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
  • Infectious diseases suspected and special stains requested should be
  • 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.
  • For induced sputa, contact Respiratory Therapy.

SPECIMEN

Expectorate material fresh or in CytoLyt.

Sputum specimens are examined to detect benign and malignant conditions in the lung.

CONTAINER

  • Clean, leak-proof container(s).
  • Label all containers with a minimum of two patient identifiers.

PATIENT PREPARATION

  • Upon awakening, clear your throat of any material, which may have accumulated overnight and discard it.
  • Perform oral hygiene duties (i.e., brush teeth, etc.)
  • Gargle and rinse your mouth with warm water several times to reduce contamination.
  • DO NOT EAT BREAKFAST (food particles may distort results).

NOTE: A complete sputum series consists of a fresh early morning deep cough specimen each day for three days.

COLLECTION TECHNIQUE

  1.  Complete the requisition entirely.
  2.  Pre-label collection container(s) with patient name and sample site.
  3.  Cough deeply several times during the first hour that you are wake. Sputum must come from lungs, not saliva (NOTE: Optimum specimen collection is within 15 – 30 minutes   of waking  This is best accomplished by sitting up straight, breathing deeply, and coughing forcefully)
  4.   Expectorate all material (ideally 2-5 tablespoons) into the labeled specimen container   (NOTE:  If a good specimen is not obtainable by this method, obtain an induced         sputum with the assistance of Respiratory Therapy Department).
  5.   Repeat steps if completing sputum series collection
  6.   Seal container well to prevent leading.
  7.   Place labeled container (s) into a Biohazard specimen bag and include the completed requisition in the outside pocket of the bag.
  8.   Send the entire specimen to the laboratory as soon as possible.
  9.   If transport is delayed more than 24 hours, add an equal volume of CytoLyt.

**REFRIGERATE ALL CYTOLOGY SPECIMENS IF IMMEDIATE DELIVERY TO LAB/CYTOLOGY IS NOT POSSIBLE**

CAUSES FOR REJECTION

  • Incomplete requisition.
  • Specimen container not properly labeled.
  • Specimen fixed with formalin.
  • Saliva or nasal aspirates.
  • Contaminated container.

LIMITATIONS

  • If bronchial cells and/or dust-pigmented macrophages are not identified, the specimen may be reported as unsatisfactory for adequate evaluation.
  • Not all cancer can be detected, especially, peripheral or “coin” lesions.

METHODOLOGY:

  • Thin layer preparation is examined microscopically using the Pap stain method.
  • Cell block specimens prepared and stained using Hematoxylin & Eosin (H & E) stain method.
  • Special stains and special studies (IHC, ISH, molecular, etc.), if needed.

ADDITIONAL INFORMATION

  • When a pulmonary lesion is suspected, a complete series should be examined.

NOTE: The complete sputum series consists of a fresh, early morning deep cough specimen each day (3 days) for the series. The complete sputum series increases the detection of                    primary bronchogenic carcinoma from 45% (one specimen) to 86% (three specimens).

  • A post-bronchoscopy sputum should be included in the series.
  • Sputum cytology can usually distinguish between non-small cell carcinoma and other carcinomas.
  • Although occasional cases of infectious pulmonary disease are detected or suspected cytologically, culture, biopsy, or bronchoalveolar lavage/washings are more productive in detection of infections.
  • Microbiology studies are not a part of this procedure. They must be ordered separately.

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

Please call laboratory if you have questions.