Diagnostic cytology

9.30am to 5.30pm, Monday to Friday (except bank holidays and excluding weekends).  

All samples should reach the laboratory as soon as possible and preferably early in the working day to avoid deterioration of cells. Samples should be received in the department by 4.00pm. 

If a delay in transportation is anticipated or samples have been taken out of hours then they should be kept refrigerated at 4°C.  

There is no out-of-hours cytology service. 

All cytology request forms, sample containers, glass slides and slide boxes must be labelled and completed as per the following  

Acceptance criteria  

Cytology request forms, sample containers/slides/slide mailer boxes must have a minimum of 3 key patient identifiers, and these patient identifiers must include: 

• Full name (first name and surname)  
• A unique patient identification number, hospital, NHS or 
• Date of birth  

Rejection criteria  

Samples will be rejected if: 

• The request form, sample container or slide has less than 3 of the key patient identifiers 
• The patient data on the form and sample container do not match.  

Cytology request forms and samples containers/slides/slide boxes that do not meet these standards will need verifying by a senior clinician. And in such cases the requesting clinician will be asked to visit the diagnostic cytology department to verify the request form and specimen or complete a specimen deficiency form, accepting responsibility for any clinical decisions that are made based on the results of the sample submitted.

Sample pot lids and slide boxes must be secured properly and checked to ensure no leakage or that slides cannot fall out.  

The sample container/s/slide boxes must be placed in a clear plastic transport bag, and sealed properly, with the accompanying request placed in the side pocket.

Forms should not be stapled to the bag or placed with the samples.

Diagnostic cytology samples must not be placed in formalin, 10% Formal saline or Neutral Buffered Formalin. 

Cytology samples not being delivered and received by the lab ASAP  

• These specimens (unless they have been placed in preservative as outlined above) do not contain any preservatives/fixatives that prevent the cells from deteriorating or prevents microbes from growing. The longer a specimen takes to reach the lab there is an increased chance that the cells will deteriorate and that the sample may become unsuitable for diagnosis.  
• CSF cells deteriorate rapidly, so a delay may mean that a diagnosis may not be possible.  

Delayed samples not being refrigerated (4°C)  

• These specimens (unless they have been placed in preservative) do not contain any preservatives/fixatives that prevent the cells from deteriorating or prevents microbes from growing. Placing them in a fridge will help to slow down cell deterioration and microbial growth, especially important with urine samples. 

 Patient not being prepared properly and therefore not obtaining the best sample possible 

• If serous fluid is being sampled and the patient has been supine for a long time it is important to get them to sit up and move a little to re-suspend the cells that have settled.  
• Sputum samples should be taken first thing in the morning before patient has eaten or brushed their teeth. 
• Sputum samples need a very deep cough and it is recommended that this is obtained by a physiotherapist. If this is not done the sample may just be saliva.  
• Early morning urine should be avoided because the cells will appear degenerate and interpretation will be difficult.  

FNA technique inadequate  

• Sample does not contain the cells needed to make a diagnosis and may be heavily blood stained.  

FNA smears inadequate  

• If sample is too thick the viewing of cells down the microscope is difficult, only a small drop of sample needed  
• If sample is all over the slide, cells at the sides of the slide may be lost or uninterpretable 
• Cells squashed/smashed when slide pressure applied was too great. 

FNA smear incorrectly fixed 

• Slow drying causes air drying artefact where the cells appear bigger and lack definition. 
• If the slide is incorrectly labelled wet or dry, the wrong stain may be applied in the lab making interpretation difficult. 

FNA smear on back of slide  

• If the smear is placed on the back of the slide and not the front, cells or even the whole sample might be removed when being handled by lab staff. 

We aim to report on diagnostic cytology specimens within 48 hours of receipt into the laboratory. 

Urgent samples 

In some circumstances a report may be required urgently. In these cases the request form must be marked “URGENT” and with a contact name and telephone/bleep number.

In exceptional circumstances, for some cases, it is possible to obtain results on the same day as sampling. Such requests must be discussed beforehand with one of the consultant histopathologists.