Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
1 of 13
Date of Issue
02.12.2010
Cytology Handbook
VERSION No
4.3
DATE OF ISSUE
18.05.07
REVIEW INTERVAL
Every two years or when there are any changes to
the procedures
AUTHORISED BY
R Evans
AUTHOR
R Evans
COPY
Intranet, Extranet and Internet
LOCATION OF COPIES
1. On Great Western Hospital Intranet Website
2. Q-Pulse™
Document review history
Review date
Reviewed by
16.8.10
R.Evans
29.11.10
R. Evans
21.11.11
R.Evans
1.2.12
R.Evans/J.Scurr/
P.Tidbury
Signature
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
2 of 13
Date of Issue
02.12.2010
Contents
0
General Information ................................................................................................................... 3
1
Contact Details ............................................................................................................................. 4
2
Service Availability ..................................................................................................................... 4
3
Results............................................................................................................................................ 5
4
Specimen Transport .................................................................................................................... 6
5
Request Forms .............................................................................................................................. 6
6
Health & Safety ............................................................................................................................ 7
7
Quality Management .................................................................................................................. 8
8
SAMPLE REQUIREMENTS FOR CYTOLOGY TESTS ...................................................... 9
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
3 of 13
Date of Issue
02.12.2010
0
GENERAL INFORMATION
The Clinical Pathology Service is provided by the laboratories at the Great Western Hospital,
Swindon. We provide an analytical and interpretative service on a wide-range of clinical
specimens. Our efficiency depends to a large extent on your cooperation. Your compliance
with a few rules concerning safety, specimen identification and transport will greatly help us to
deliver the service you need. We hope that this handbook outlines all the information you
require to use our service. However, please feel free to contact us to discuss any problems or
issues you may have. Any comments or suggestions about the User Handbook should be
addressed to the Quality Manager.
Cytopathology
Cytopathology involves the examination of individual cells:1. Pre-malignant changes (as in the Cervical Screening Programme involving 25-65 year
old women using Liquid Based Cytology techniques)
2. Diagnostic features in “non – gynae specimens” eg. Body fluids, fine needle aspirates of
lumps.
Cytopathology at The Great Western Hospital also provides a Semen Analysis service for
fertility checks and post vasectomy checks.
We aim to be a model of excellence in the delivery of a clinical pathology service. In order to
achieve this, we are committed to the following:








Service user involvement
Good professional practice & evidence-based practice
Efficient utilization of resources
Valuing our staff in order to realize their full potential
Commitment to the health, safety and welfare of our patients, staff and visitors
Keeping a safe environment in compliance with current environmental legislation
Working as teams and partnerships
Continuous improvement
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
4 of 13
Date of Issue
02.12.2010
1
CONTACT DETAILS
Cytology
Office
Cytology
Consultant Cytopathologist
Dr Judy Scurr
Cytology
Consultant Cytopathologist
Dr Penny Tidbury
Cytology
Lead BMS3 Cytology
Mrs Rosemary Evans
2
01793
604999/5000
01793
605000
01793
605000
01793
604284
SERVICE AVAILABILITY
The laboratories are open for receipt of specimens from 0830 to 1700 between Monday and
Friday.
Semen analysis samples
The laboratory operates a pre-booked appointment system for Fertility and Post vasectomy
samples
A Fertility or Post vasectomy kit must be used. These are available on request from pathology
stores and contain
 A patient information sheet for the patient to read and complete
 A pre-checked specimen container
 If e requesting is available please use this method.
Print a copy of the e request form and give to the patient to bring to his appointment
with his specimen/kit.
If e requesting is not available please use a blank request form which the
clinician/doctor has to complete and sign
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
5 of 13
Date of Issue
02.12.2010
3
RESULTS
Please note that we need to establish the caller’s identity before giving results over the
telephone. We are unable to give results directly to patients or their relatives.
Authorised results are available on the Medway system and the Ward Enquiry system. Results
may also be obtained by telephoning extension 5000 (direct dial 01793 605000).
The average turnaround times from specimen received in the laboratory to reported are:1. Cervical Screening samples
7-10 days
URGENT SAMPLES MUST HAVE URGENT OR FAST TRACK WRITTEN
CLEARLY ON THE REQUEST FORM.
Any samples where the request form states ?malignant will also be fast tracked.
2. Non – gynae samples
1-2 working days or slightly longer if
further tests required.
PLEASE NOTE: IF AN URGENT REPORT IS REQUIRED THE CLINICIAN MUST
DISCUSS THE CASE WITH A CONSULTANT CYTOPATHOLOGIST TO
ARRANGE THIS.
IF A CONSULTANT IS NOT AVAILABLE A SENIOR MEMBER OF LABORATORY
STAFF MUST BE CONTACTED ON ext 4284.
“URGENT SAMPLE” MUST BE CLEARLY WRITTEN ON THE REQUEST FORM
WITH NAME AND CONTACT NUMBER OF REQUESTING CLINICIAN
3. Post Vasectomy samples
4. Fertility checks
1-2 working days
2 working days
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
6 of 13
Date of Issue
02.12.2010
4
SPECIMEN TRANSPORT
Specimens must be delivered to the laboratory as soon as possible in order to provide the best
service and keep turnaround times to a minimum.
LBC samples for cervical screening taken at GP surgeries must be included in the earliest
Tilley run after the sample has been taken in order to help comply with the 14 day
turnaround time required by the Department of Health from 1st January 2011.
5
REQUEST FORMS
a. Non gynae and Semenology specimens
All samples must be accompanied by a properly completed request form -ideally an
electronically requested CYTOLOGY form or, if not, a Pathology request form (green printing
on white), giving full patient demographics, relevant clinical information, patient location and
detailing the investigation required.
Please note that inadequately labelled specimens and those not accompanied by adequately completed
request forms may not be processed.
Electronic requesting will be available for hospital samples in the near future. Rollout is
expected during 2012
Please note: Samples requiring multiple tests in different laboratory departments
e.g. pleural fluids requiring Microbiology, Chemistry and Cytology analysis need separate
forms and containers. .
The Cytology Department does not perform cell counts
b. Cervical cytology (LBC samples)
Please use the electronic request system. If electronic requesting is unavailable, you
may use an Open Exeter form (available in HMR101/5 portrait format) from the
Open Exeter System.
When using electronic requesting please ensure that all dates are correct and include
any past history dates and result codes eg 2A or 2R (available from Open Exeter) This
enables us to determine the correct recall for the woman.
Hospital or Community clinic samples
Green request form available from pathology stores (see above for completion of boxes)
Electronic requesting will be available for hospital samples in the near future. Rollout is
expected during 2012
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
7 of 13
Date of Issue
02.12.2010
6
HEALTH & SAFETY
All specimens should be regarded as potentially infectious.
Certain specimens from patients who are known or suspected to have the following
diseases/conditions constitute a potential higher risk of infection to persons handling the
specimens:
 Tuberculosis (specimens from sites where tuberculosis infection is likely)
 Anthrax
 Brucellosis
 Transmissible Spongiform Encephalopathy - including CJD [Creutzfeldt- Jakob Disease]
 Viral haemorrhagic fever
 Pandemic Flu
To minimise the risks “Danger of Infection” labels should be attached to the specimen
container and request form for all qualifying specimens (available from Phlebotomy Dept,
GWH) and the nature of the risk specified on the request form. This is a necessary procedure
to protect persons handling the specimens (nursing, portering, transport, reception and
laboratory staff). The labels must be used in accordance with the Specimen Transportation
Policy available on the Trust intranet.
The Consultant Microbiologist must be contacted before collecting specimens from a patient
suspected of having a viral haemorrhagic fever, human avian influenza, SARS (Severe Acute
Respiratory Syndrome) or CJD.
Samples thought to constitute a risk to staff because of inadequate packing or warning may be
rejected.
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
8 of 13
Date of Issue
02.12.2010
7
QUALITY MANAGEMENT
The Pathology Service is committed to maintaining accreditation for its quality management
system. Accreditation is undertaken by Clinical Pathology Accreditation (UK) Ltd, an
independent external organisation.
Details of our accreditation, together with performance data, are available from the Quality
Manager.
In order to help us improve our service, we may ask you to complete a questionnaire. We
greatly value the information obtained from these surveys, and we would like to thank you in
anticipation of your assistance in completing the questionnaires.
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
9 of 13
Date of Issue
02.12.2010
8
SAMPLE REQUIREMENTS FOR CYTOLOGY TESTS
SAMPLE
(CONTAINER/VOLUME)
SPECIAL
REQUIREMENTS
AVAILABILITY
TURNAROUND TIME
FACTORS AFFECTING
TEST PERFORMANCE/
COMMENTS
Ascitic Fluid for
Cytology
Plain white top universal
container. Not >40mls
Not >40mls
unless
specifically
requested by
Consultant
Cytologist
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
A separate cytology
specimen and form is
required. Cytology do
not perform cell
counts on fluids.
Breast Cyst Fluid for
Cytology
Plain white top universal
container. As available
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
Please send separate
days (may be longer if
forms/samples for
immunocytochemistry Cytology/Microbiology
is required)
and Chemistry
Bronchial Brushings
for Cytology
Slides must be labelled in
PENCIL with name,
DOB/Hosp no. Place fixed
and dry slides in separate
containers & specify on slide
F for fixed, U for unfixed.
Snip off brush into Cytolyte
solution. & agitate vigorously
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Bronchial Washings /
Lavages for Cytology
Plain white top universal
container or dedicated
endoscopy kit
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
INVESTIGATION/TEST
Slides &
Cytoloyt bottle
avaiable from
Cytology Dept
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
10 of 13
Date of Issue
02.12.2010
INVESTIGATION/TEST
Cervical Samples
Cerebrospinal Fluid
(CSF) for Cytology
Fine needle aspirate
PLEASE SPECIFY SITE
OF FNA ON REQUEST
FORM
SAMPLE
(CONTAINER/VOLUME)
SPECIAL
REQUIREMENTS
AVAILABILITY
TURNAROUND TIME
LBC Vial
Ensure all
sections of the
request form
are completed
Vials must reach the
lab on the next
available
courier/tilley run in
order to comply with
TAT requirements
Result issued from
laboratory within 10
days of sample being
received into the
laboratory
Plain white top universal
container.
NB. Please send
all CSF sample
pots to
Microbiology
first.
Minimum 1 fixed slide, 1 dry
slide + 1 bottle of needle
washings
Slides and
needle washing
bottles kits
available on
request from
cytology dept
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
FACTORS AFFECTING
TEST PERFORMANCE/
COMMENTS
Cell counts are
performed by
Microbiology.
Cytology analysis is for
the detection of
malignant cells only
Slides must be
labelled in PENCIL
with name, DOB/Hosp
no. Immediately fix 1
slide with fixative &
label fixed slide F and
place in "fixed" slide
container. Place
thoroughly dry slide in
"air dried" slide
container. FNA
instructions available
on request (CYT-F003)
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
11 of 13
Date of Issue
02.12.2010
FACTORS AFFECTING
TEST PERFORMANCE/
COMMENTS
INVESTIGATION/TEST
SAMPLE
(CONTAINER/VOLUME)
SPECIAL
REQUIREMENTS
AVAILABILITY
Joint Fluids for
Cytology
Plain white top universal
container. As available
NB. Crystals
analysis
performed by
microbiology
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
Please send separate
days (may be longer if
forms/samples for
immunocytochemistry Cytology/Microbiology
is required)
and Chemistry
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Slides must be
labelled in PENCIL
with name, DOB/Hosp
no. Immediately fix 1
slide with fixative &
label fixed slide F and
place in "fixed" slide
container. Place
thoroughly dry slide in
"air dried" slide
container
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
Please send separate
days (may be longer if
forms/samples for
immunocytochemistry Cytology/Microbiology
is required)
and Chemistry
Nipple Discharge for
Cytology
Minimum 1 fixed slide, and if
sufficient material, 1 dry
slide
Oesophageal
Brushings for
Cytology
As for Bronchial Brushings,
place fixed and dry slides in
separate containers
Ovarian Cyst Fluid for
Cytology
Plain white top universal
container. Not >20mls
Slides available
on request from
cytology dept
Not >20mls
unless
specifically
requested by
Consultant
Cytologist
TURNAROUND TIME
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
12 of 13
Date of Issue
02.12.2010
INVESTIGATION/TEST
Peritoneal Fluid for
Cytology
Peritoneal Washing
for Cytology
SAMPLE
(CONTAINER/VOLUME)
Plain white top universal
container. Not >40mls
Plain white top universal
container. Not >40mls
Pleural Fluid for
Cytology
Plain white top universal
container. Not >40mls
Semen Sample for
Fertility Studies or
Post Vasectomy
Reversal
Fertility Study Kits available
from Pathology Stores.
Complete ejaculate required
SPECIAL
REQUIREMENTS
Not >40mls
unless
specifically
requested by
Consultant
Cytologist
Not >40mls
unless
specifically
requested by
Consultant
Cytologist
Not >40mls
unless
specifically
requested by
Consultant
Cytologist
Samples should
be produced
within a hour of
appointment
time and
delivery to
Pathology
reception
AVAILABILITY
TURNAROUND TIME
FACTORS AFFECTING
TEST PERFORMANCE/
COMMENTS
Specimens accepted
to department
8.30am - 5pm
Please specify
average 1-2 working
whether fluid or
days (may be longer if
washings. Cytology do
immunocytochemistry
not perform cell
is required)
counts on fluids.
Specimens accepted
to department
8.30am - 5pm
Please specify
average 1-2 working
whether fluid or
days (may be longer if
washings. Cytology do
immunocytochemistry
not perform cell
is required)
counts on fluids.
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Appointments must
be pre booked by
patient. See patient
info sheet in kit for
details
average 2 working
days
A separate cytology
specimen and form is
required. Cytology do
not perform cell
counts on fluids.
Cytology User Handbook
Great Western Hospitals NHS Foundation Trust Pathology Service
DCN: CYT-P-004
Department of Cytology
Page
13 of 13
Date of Issue
02.12.2010
SAMPLE
(CONTAINER/VOLUME)
SPECIAL
REQUIREMENTS
AVAILABILITY
TURNAROUND TIME
Semen Sample for
Post Vasectomy
Checks
Post Vasectomy Kits available
from Pathology Stores.
Complete ejaculate required
Samples should
be produced
within 2 hours
of appointment
time and
delivery to
Pathology
reception
Appointments must
be pre booked by
patient. See patient
info sheet in kit for
details
average 1-2 working
days
Skin Scrapings for
Cytology
Slides must be labelled in
PENCIL with name,
DOB/Hosp no. & fixed
immediately
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Sputum for Cytology
1 expectorate after deep
cough into a plain silver
lidded sputum container
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Thyroid Cyst Fluid for
Cytology
Plain white top universal
container. As available
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
Urine for Cytology
Whole voided urine (not
early morning urine or mid
stream sample) in a 500ml
cytology urine container
available from Pathology
Reception
Specimens accepted
to department
8.30am - 5pm
average 1-2 working
days (may be longer if
immunocytochemistry
is required)
INVESTIGATION/TEST
Whole voided
urine required
not early
morning urine
FACTORS AFFECTING
TEST PERFORMANCE/
COMMENTS
Patient information
sheet CYT-F-013
Please do NOT use
Boric acid containers.
See Patient
Information Leaflet
CYT-F-015
Cytology User Handbook