The purpose of a cytological examination is generally for the cytological detection of malignancy. Cytology laboratory offers screening of cervical-vaginal samples and the interpretation of non-gynecological and fine needle aspiration (FNA) specimens with the ultimate goal of attaining the most accurate and complete diagnosis possible. The goals of the service include:
Services provided by the laboratory include:
Other services available :
Some cytological specimens require immediate fixation while others need to be fresh/unfixed specimens. All fresh/unfixed specimens should be sent to the laboratory immediately.
CSF and vitreous fluid degenerate within one hour, even with refrigeration. It should be collected in Shandon fixative and sent by hand to the Cytology Laboratory as soon as possible.
Bronchoalveolar lavages and sputum specimens that require differential cell count testing are to be transported at 4°C (on ice) and delivered within 1 hour following collection of specimen. All primary containers must be clearly labelled with at least two patient-specific identifiers, e.g. Patient’s NRIC number and patient’s name. In the case of prepared smears, all glass slides must be clearly labelled with the patient’s NRIC number and patient’s name. In the event that more than one site is aspirated, the site must be clearly indicated on each slide and mailer.
Requests for special tests (e.g. detection of TB, fungi, crystals, immunocytochemistry, cell block preparation etc., must be clearly indicated under the special instructions tab in the histopathology CPOE electronic request.
Please contact cytology laboratory at 6321 4954 for urgent specimens that require same day reporting. Urgent cytology specimens should be indicated on the request form and delivered immediately by hand to the cytology laboratory.
Please refer to following sections for site specific collection instructions:
The cervical (Pap) smear is a screening technique to aid in the detection of cancer and cancer precursors of the uterine cervix. It is not a diagnostic procedure. Both false-positive and false-negative results have been experienced with Pap smears. Accordingly, any lesion detected on screening should be biopsied. The Pap smear should not be used as the sole means to diagnose or exclude malignant and premalignant lesions.
With effect from 7 September 2016, all specimens are to be submitted with CPOE requests and are to be labelled with their respective CPOE labels. Ordering clinicians are reminded to save the order at the end of entry to ensure proper submission of the CPOE request. Submit one request for the same patient at the same operation, irrespective of the number of specimens taken. In the event that CPOE system is not available, test request forms should be submitted. The request must include:
It is imperative that these instructions be strictly adhered to, omission of which may result in delay of reporting.
Successful methods of specimen collection include the following:
(A) Liquid-Based (ThinPrep) Gynaecological Cytology (a) Broom-Like Device Protocol - extracted from Hologic Publication
Note: Under no circumstances should the speculum be lubricated with medical jelly as it can make the Pap test unsatisfactory. (b) Endocervical Brush/ Spatula Protocol - extracted from Hologic Publication
Note: Under no circumstances should the speculum be lubricated with medical jelly as it can make the Pap test unsatisfactory
Figure 1. Sampling of the Cervix with Three Different Instruments: Spatula, Brush, and “Broom.”
Figure 2.To transfer material from the spatula, smear the sample with a single stroking motion using moderate pressure to thin out clumps of cellular and mucus material. Avoid excessive force or manipulation, which will damage cells.
Figure 3. To transfer material from the brush, roll the bristles across the slide by rotating the brush handle.
Figure 4. To transfer material from the broom, smear the sample with a painting action, using both sides of the broom.
Introduce an extended-tip spatula into the endocervix. Rotate the spatula through 360° pivoting at the os. Withdraw the spatula and put aside temporarily, keeping the material on the spatula.
Introduce an endocervical brush device into the cervix. Rotate the brush 90° - 180°. (A brush is not recommended in pregnancy, cervical stenosis, or other clinical conditions indicated by the manufacturer).
Spread the spatula specimen onto the left side of the slide and fix while covering the right side (see Figure 5).
Figure 5. Spread the spatula sample over the left side of the slide and fix while covering the right side. Roll the brush over the right side of the slide and fix.
(A) Inadequate Smears
(B) Endocervical Cell / Transformation Zone (EC/TZ) Component
At least 10 well preserved endocervical columnar cells or squamous metaplastic cells qualify as an EC/TZ component.
If <10 cells are seen, the EC/TZ component is reported as absent.
A. Smear Preparation
Label all slides with patient’s NRIC and name on the frosted end of the slides using a hard lead pencil prior to smear preparation.
B. Fluid
Maximum volume of fluid sent should not be more than 300 mL, in an aliquot of 50 mL.
C. BAL and Sputum Fluids for Differential Cell Count
D. Eyelashes for Demodex Investigation
With effect from 7 September 2016, all specimens are to be submitted with CPOE requests and are to be labelled with their respective CPOE labels. Submit one request for the same patient at the same procedure, irrespective of the number of specimens taken. In the event that CPOE order is not available, test request forms should be submitted. The request must include:
Ordering clinicians are reminded to check the following boxes before submission:
Specimen label completed
Vetted and order form completed (Dr only)
If there is an additional test (e.g.: immunocytochemistry, molecular, FISH) to be done after a case has been reported, a new CPOE request has to be submitted. The respective CPOE label has to be sent to the laboratory. The request must include:
Patient’s name, age, sex and identification number
Patient’s exact location (hospital/department/clinic/ward/bed)
Submitting physician’s name, MCR number and telephone number
Consultant-in-charge’s name and MCR number
Source of specimen/anatomic site sampled
The number and type of specimens submitted (containers of fluid, slides, etc.)
Test requested (under the special instructions tab)
Relevant clinical findings and history, including operative findings, previous laboratory accession number or date of previous operation
Provisional diagnosis
Failure to provide ALL the above information will delay turnaround time for the Cytology report.
Click here to view all Gynaecological Cytology (Pap smear) tests Click here to view all Non-gynaecological Cytology tests
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