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PULMONARY SPECIMENS
The adequacy of a sputum specimen is determined
primarily by the presence of alveolar macrophages indicating that
the specimen obtained is a deep cough specimen producing material
from the lower airways. In addition, the specimen should not be
obscured by oral or upper airway contaminants.
Adequate bronchial brushing and washing
specimens should contain large numbers of well preserved bronchial
lining cells with as little contaminating oral and upper airway
material as possible. Bronchoalveolar lavage specimens should contain
abundant, well-preserved, alveolar macrophages with as little contaminating
upper airway material as possible.
Procedure: Sputum
| Indications: |
For the detection
and characterization of premalignant/malignant pulmonary lesions.
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| Specimen
Required: |
5 mL (about
one teaspoon), or more if possible, of sputum obtained from
a deep cough specimen.
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| Supplies: |
Clean plastic
specimen container; fixative (Saccomanno fixative)
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| Collection
Procedure: |
When clinically
feasible, sputum specimens should be obtained as follows. The
optimum time for specimen collection is within 15 to 30 minutes
after waking and before eating breakfast. Brushing of teeth
or rinsing of the mouth thoroughly with water will reduce contamination
by saliva. Instruct the patient to inhale and exhale deeply,
forcing air from the lungs using the diaphragm. Repeat until
the patient coughs and is able to produce a sputum specimen.
Collect the specimen in the container, attempting to obtain
at least one teaspoon of sputum, add 50 mL of Saccomanno
fixative. If transport time will be less than 24 hours, or
fixative is not available, the specimen should be refrigerated
or kept on wet ice until transport to the lab. Greater diagnostic
yield may be obtained if specimens are submitted on three to
five successive mornings. Label the container with correct
patient information and submit the specimen along with the
completed cytology request form to the Cytopathology Laboratory.
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NOTE :If
a good specimen is not obtainable by this method or if the patient
is unable to comply, obtain an induced sputum or tracheal aspirate.
NOTE: The
Cytopathology Laboratory will not accept induced sputum samples
for the cytologic detection of Pneumocystis carinii, fungi, or
acid fast bacilli. If a bronchoalveolar lavage cannot be obtained,
the preferred methodology for detection of P. carinii is by fluorescent
antibody testing performed in the Microbiology Laboratory. Sputum
specimens for fungi and acid fast bacilli may also be submitted
to the Microbiology Laboratory for rapid detection procedures of
these organisms.
Procedure: Post-Bronchoscopy Sputum
Collect one good deep cough specimen
at any time during the 24 hour period following bronchoscopy,
as outlined above. Submit the specimen to the Cytopathology
Laboratory, along with the completed cytology request form.
Procedure: Bronchial Brushings
| Indications: |
For the detection
and characterization of bronchoscopically visible premalignant/malignant
pulmonary lesions; for the identification of some microbiologic
pathogens (primarily viral and fungal).
|
| Specimen
Required: |
Bronchoscopically-directed
brushing of the identified lesion. |
| Supplies: |
Standard
bronchoscopy equipment. One Coplin jar with fixative (Saccomanno
fixative or 95% ethyl alcohol), slides.
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| Collection
Procedure: |
Using standard
bronchoscopy technique, identify the lesion in question and
obtain a brushing sample of the lesion. Roll/smear brush on
slides; fix. DO NOT submit brush to laboratory. |
Procedure: Bronchial Washings
| Indications: |
For the detection
and characterization of bronchoscopically ill-defined or invisible
premalignant/malignant pulmonary lesions; for the identification
of some microbiologic pathogens (primarily viral and fungal).
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| Specimen
Required: |
Bronchoscopically-obtained
washing (preferably at least 10 mL) of the bronchi in the region
of the suspected lesion.
|
| Supplies:/ |
Standard
bronchoscopy equipment. 120 mL clean plastic specimen container(s).
Fixative (Saccomanno fixative).
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| Collection
Procedure: |
Using standard
bronchoscopy technique, lavage the distribution of the bronchus
to be sampled. Collect the wash in a clean container. Add 50
mL of Saccomanno fixative. Label the container with correct
patient information and submit the specimen, along with the
completed cytology request form, to the Cytopathology Laboratory. |
Procedure: Bronchoalveolar
Lavage (BAL)
| Indications: |
For detection
and characterization of malignancy; identification of some
microbiologic pathogen (viral, fungal), and detection of some
other elements (lipid-laden or hemosiderin-laden macrophages).
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| Specimen
Required: |
Bronchoscopically-obtained
lavage (preferably at least 20 mL) of the distal airway and
alveoli in the distribution of the suspected lesion.
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| Supplies: |
Standard
bronchoscopy. 120 mL clean plastic specimen containers.
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| Collection
Procedure: |
Using standard
bronchoscopy BAL technique, lavage the lung distribution in
question with normal saline (or other physiologic solution).
Collect the lavage specimen in a clean specimen container.
Label the container with the correct patient information and
submit the specimen, along with the completed cytology request,
to the Cytopathology Laboratory. If transport will be delayed, refrigerate
the specimen. Do NOT add fixative to the
specimen.
Lipid-Laden Macrophages (Oil Red O): Do NOT add fixative to the
BAL. Lipid ladens receive no fixative. MUST be received FRESH.
Note on requisition that specimen is for lipid-laden macrophages.
Hemosiderin-Laden Macrophages (Iron Stain): BAL should be received
FRESH. Do NOT add fixative. Note on requisition specimen is for
hemosiderin-laden macrophages.
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NOTE: BAL
specimens sent for the culture must be split from the main
specimen prior to transport. The Cytopathology Lab does not
have facilities for the sterile handling of BAL specimens
necessary for culture procedures.
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NOTE: For
the interpretation of BAL specimens, relevant clinical information
must be provided.
Adopted MKurtinecz, 12/04
Reviewed MKurtinecz, TSp 12/04
Reviewed MKurtinecz, TSp 1/06
Reviewed MKurtinecz,TSp 5/07
Revised MKurtinecz, TSp 7/08
Reviewed: MKurtinecz, TSp 8/09
Supersedes: CytoCollFeb2001 Manual
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