Body Fluid Cytology

NAME OF PROCEDURE

Body Fluid Cytology

TEST CODE

NGYN

SYNONYMS

Body Cavity Fluid Cytology; Effusion Cytology, Non-Gyn Cytology, Fluids Cytology

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

APPLIES TO

Abdominal Fluid Cytology; Ascitic Fluid Cytology; Culdocentesis; Cyst Fluid Cytology; Gastric Washing Cytology; Paracentesis Fluid Cytology; Pericardial Fluid Cytology; Pericardiocentesis fluid Cytology; Peritoneal Fluid Cytology; Pleural Fluid Cytology; Synovial Fluid Cytology; Thoracetesis Fluid Cytology.

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 or chemotherapy) is essential to interpretation and should be noted on the requisition.  Infectious diseases suspected and special stains requested should be specified. Clinical evidence of immunosuppression should be indicated.  Special handling requirements (isolation) should be clearly noted on the requisition. If culture is also requested make sure specimen is provided to Microbiology.

CONTAINER

Capable plastic container, vacuum canister, bag, or bottle.  Please label all containers with a minimum of two patient identifiers.

PATIENT PREPARATION

To suspend the cells in the fluid collected, move the patient into several different positions prior to aseptically performing the aspiration.

COLLECTION TECHNIQUE

Add 500 units of heparin per 100 ml of fluid anticipated (each ml heparin contains 1000 units). Gently agitate the flask as fluid is collected to mix the heparin with the fluid.

NOTE

It is not necessary to combine peritoneal washings or gastric washings with an anticoagulant (heparin). “See Below”

Send a separate container marked for Cytology if possible. This will speed the handling of the specimen thus insuring optimum preservation and evaluation. Label with patient’s name, date, time of collection, and type of specimen. Deliver immediately to the laboratory. refrigerate specimen if it cannot be processed promptly.

SPECIAL INSTRUCTIONS FOR GASTRIC WASHINGS

Patient Preparation:

The patient must be fasting overnight. Keep the patient hydrated by having him/her drink water or tea during the night, especially one hour prior to the procedure. If there is an obstruction, continuous suctions should be maintained overnight and the patient should be kept hydrated using IV fluids. If barium has been given, the procedure must be delayed one week.

Collection Technique:

A Levine tube is introduced in the usual manner to the 75 cm mark. No lubrication is used except by moistening the tube with ice. Repeated amounts of Ringer’s solution is injected under pressure, aspirated, and discarded until the return is clear. 500 ml of Ringer’s solution is then introduced under maximum pressure and re-aspirated while the abdomen is vigorously massaged. The aspirated fluid is then placed in a capable plastic container, send the specimen to the laboratory immediately, packed in ice, or add an equal volume of Cytolyt to the entire specimen or to a 50 to 100 ml aliquot of the sample.

REQUEST FORM

Complete a Anatomical Pathology Requisition as indicated in the Test Ordering section of this manual.  The patient information section as well as the Non-Gyn portion of the form should be completed.

CAUSES FOR REJECTION

  • Specimen container not properly labeled.
  • Fixation of any type (except for gastric washing).
  • Gross contamination due to spillage
  • Prolonged period (more than 8 hours) at room temperature

LIMITATIONS

Allowing fluid to stand for a prolonged period before processing may cause deterioration and artifact.

Cells in fluids of long duration may be degenerated on first tap and a second tap may be required after re-accumulation for best cytologic detail.

Clots may contain diagnostic cells which are unavailable for sampling.

METHODOLOGY

Smears and thin layer preparations are examined cytologically using the Pap stain method. When possible, cell blocks and tissue fragments are processed and are also examined cytologically. Special stains as needed.