Specimen Collection Instructions

Call for specimen submission instructions at 541-222-6950. A pathologist can also perform this procedure in our office. Appointments are arranged by calling 541-222-6915.

Components: Estrogen Receptor, Progesterone Receptor, HER2/neu, Ki-67.

Newly diagnosed breast cancer is routinely tested for estrogen receptors, progesterone receptors, HER2/neu overexpression and a proliferation index determined by Ki-67 (MIB1). This is done as a panel and reported with the diagnosis and prognostic markers (tumor size, tumor grade, etc.).

The testing is performed on formalin-fixed, paraffin-embedded tissue. Interpretive guidelines will be included on each report.

Call in advance at 541-222-6950 for courier pick-up. Tissue should be accompanied by a copy of the mammogram and specimen radiograph (X-ray).

There is a growing consensus among pathologists that optimal evaluation of needle-localized breast biopsies frequently involves thorough fixation of the specimen prior to cutting/sectioning of the specimen. This is particularly true for specimens obtained because of microcalcifications.

Immediate gross examination is usually not necessary for needle-localized biopsies unless the surgeon encounters a mass lesion that is at the surface of the excised specimen. In this case, immediate evaluation may be useful to determine if there is gross invasive cancer at the margin. Needle-localized biopsies should be accompanied by copies of the mammogram and a specimen radiograph that is obtained at the time of specimen removal.

In specimens greater than 2 cm in diameter, specimen orientation (usually by sutures) is important. After fixation, the pathologist will ink the resection surfaces, serially divide the tissue into thin slices and perform a combination of laboratory X-rays (Faxitron) and mapping to isolate all of the calcifications and ensure that appropriate tissue is processed.

This special processing may require one to two additional days to complete the final report.

Diagnostic cytology permits the examination of virtually every organ system in the body through the evaluation of epithelial cells obtained from fluids, solid lesions and organ surfaces. In general, evaluative techniques that involve direct collection of specimens through scraping, brushing and aspiration of lesions will yield a higher proportion of positive diagnoses when a neoplasm is present than methods that evaluate sputum, cerebrospinal fluid or body fluid.

Types of Fixation and processing of various specimens differ and are described below. As with PAP smears, adequate sampling and specimen preparation are critical.

Cytological Sampling Technique and Transfer of Aspirated Material (PDF)

The mouth is cleansed with a water rinse prior to taking the smears. Two labeled smears from both the right and the left buccal mucosa are collected by firmly scraping the oral mucosa with a metal spatula or a saline-moistened tongue blade. The material should be spread thinly onto glass slides and immediately placed without air drying into 95 percent alcohol. When possible, it is preferable to collect this specimen in the laboratory.

This is a highly recommended technique for the follow-up of patients with previous bladder neoplasm, for patients are at high risk of developing bladder neoplasm, and for the evaluation of urothelial carcinoma insitu.

Washings are best done prior to any instrumentation by vigorously lavaging the bladder with 50 cc of saline using a syringe and catheter. Best results are with fresh washings sent immediately (less than one-hour delay) to the Cytology Department. Otherwise, the washings are added to an equal volume of Cytolyt™ fixative.

Submit all fluid collected. The specimen should be sent in fresh. To prevent clotting in a bloody specimen the specimen for cytologic examination is anticoagulated (heparin is the preferred anticoagulant). Use 1 mL of heparin (1,000 units) for every 300 mLs of fluid. Please add 0.5 mL of heparin for lesser amounts of fluid, and refrigerate the specimen. The specimen should be kept refrigerated or cooled (35-40° F) until it is received by the laboratory. Do not add fixative to these specimens!

Breast secretions may be aspirated from the nipple surface with a pipette or syringe (no needle) and immediately placed in Preserv Cyt™ solution. For optimum overall quality of the sample for diagnosis, it is recommended that several expressed secretions be made during the procedure. The Preserv Cyt™ solution is stable at room temperature for 10 days after the specimen has been added. (Note: Pre-filled containers of Preserv Cyt™ are available upon request.) Supply Order Form.

Bronchial secretions are generally collected in a sterile mucus trap, and usually are submitted for bacteriologic and cytologic examination. These specimens should be refrigerated and transported to the laboratory as soon as possible. If a time lag of one to two hours in transportation is necessary, the specimen may be divided and material for bacteria cultured. The remaining cytologic specimen may then be fixed with Cytolyt™ fixative.

The physician collects the specimen with a fiberoptic brush technique. The brush is then rinsed into a prefilled tube of Cytolyt™ solution. The brush may or may not be detached in the solution. The solution is stable for seven days with no refrigeration after a specimen is added. (Pre-filled tubes of Cytolyt™ solution for brushes and scrapings are available upon request.) See our Supply Order Form.

Cytological Sampling Technique and Transfer of Aspirated Material (PDF)

It is advisable to communicate with the Cytology Department BEFORE doing the procedure. By using a fine needle (21-25 gauge) almost any palpable or non-palpable mass can be directly sampled with very low risk and little or no anesthetic (see technique). Some of the most common applications are peripheral lung masses, head and neck masses including thyroid nodules, soft tissue masses, breast masses, and abdominal masses, such as pancreatic masses and retroperitoneal lymph nodes. The technique can be used for culture, as well as diagnosis of neoplasm.

The aspirate is generally smeared on glass slides and the slides are immediately fixed in 95 percent ethanol (see technique). The type of specimen obtained may dictate departures from this routine (cystic lesions, granulomas, etc.). Excessively bloody specimens and tissue fragments should be fixed in Cytolyt™. Smearing these specimens may cause excessive distortion and artifact.

Tissue should be submitted unfixed in a vial of room temperature RPMI media which preserves specimen viability for other studies including flow cytometry. The specimen should be delivered to the lab within 6 hours. If a delay beyond 6 hours cannot be avoided, the tissue may be transferred to a Petri dish containing RPMI media and minced with scissors to liberate cells; the cells and tissue fragments in RPMI media can then be held in the refrigerator and delivered to the laboratory within 24 hours. RPMI media is available from the laboratory at no charge upon request. If RPMI or other tissue media is not available, sterile saline may be used. Tissue should not be allowed to dry. Supply Order Form.

Often, fine needle aspiration is best done using a syringe holder, such as the Aspir-Gun. Pathology Consultants, P.C. has provided FNA service since 1977. Drs. Meyers, DiTomasso, McCarthy and Pakalniskis have a FNA clinic located in the NSC Building on the RiverBend Medical Campus. Call 541-222-6915 for appointments.

Scrapings from suspected lesions are directly rinsed into Preserv Cyt solution. Also, direct imprint smears can be made. Fix one in 95 percent alcohol and air dry a second for Giemsa.

Smears may be made by imprinting a glass slide onto the area in question or by using a swab stick to collect material. Spread the material thinly and place while wet into 95 percent alcohol. In addition, an air dried smear for a bacteriologic or Giemsa stain is desirable.

The mouth is cleansed with a water rinse prior to taking the smear. Any suspicious lesion should be biopsied. Atypical but not grossly malignant appearing areas may be scraped with a moistened tongue blade or metal spatula. Immediately rinse blade or spatula into a pre-filled bottle of Preserv Cyt™ solution. (Note: Pre-filled bottles of Preserv Cyt™ solution for scrapings are available upon request.) See our Supply Order Form.

Three successive morning specimens are collected in wide-mouth, screw-type containers with Cytolyt™ fixative. Containers should be kept at a temperature no higher than 72-74°F after sputum collection has begun. The solution is stable for seven days with no refrigeration after a specimen is added.The best time to collect sputum is early in the morning, just after waking and before breakfast. The patient should be instructed to begin by rinsing the mouth with water to remove saliva and food particles, and to avoid contaminating the collection container with nasal secretions and saliva. Forceful vigorous coughing from deep within the chest wall usually produces adequate material. It may take 15-30 minutes of intermittent coughing for patients who have trouble raising material. Induced sputum may also be ordered for patients who have trouble raising material or who cannot produce an adequate specimen.

The patient is provided with a single wide-mouth container with Cytolyt™ fixative. The collection procedure described above for sputum cytology should be followed. These patients should also be instructed to collect sputum throughout the day.

This technique is recommended for the detection of atypical urothelial cells in heavy smokers and chemical industrial workers, and as part of the evaluation of hematuria.

First-morning urine is voided. The patient should then collect the specimen in a clean container that is provided by the laboratory. Cytolyt™ fixative can be added to the specimen in a 1:1 ratio if the specimen cannot be transported to the laboratory within two hours. If no fixative is available, the specimen can be refrigerated until it is transported to the laboratory.

Pooled 24-hours and concentrated early morning urine specimens will be rejected.

Please notify the lab at 541-222-6950 when sending specimens. The ideal specimen is an intact abnormal lymph node. Do not place in fixative. Appropriate special studies (i.e., flow cytometry, special stains, etc.) require 100-200 mg. of intact (non-crushed) tumor tissue.

Please notify the lab at 541-222-6950 when sending specimens.

The processing of sentinel nodes requires 1-2 days of additional time. Processing includes special IHC stains (cytokeratin) in order to identify very small foci of metastatic breast cancer cells. S-100 and HMB-45 stains are used for melanoma sentinel node procedures.

Molecular tests performed at Pathology Consultants, P.C. include:

Chlamydia trachomatis and Neisseria gonorrhoeae (vaginal, endocervical, male urethral swabs; ThinPrep Pap vial, urine)

Trichomonas vaginalis (vaginal, endocervical and male urethral swabs; ThinPrep Pap vial, urine)

Human papilloma virus (HPV) – ThinPrep Pap vial

Herpes simplex virus, 1 & 2 (HSV) – Swabs from anogenital lesions

Vaginal panel, candida/trichomonas/bacterial species (vaginal swab sample)

Specimen collection and handling instructions for molecular tests.

Schedule in advance with staff at 541-222-6950.  The muscle biopsy will be sent to Arkana Laboratories for testing. We have a special collection protocol available for these procedures:  PROT-340 Muscle Biopsy for Histochemical Studies Protocol. 

Schedule in advance with staff at 541-222-6950. A special collection protocol is available for these procedures. 

Submit tissue in 10 percent formalin.

Fixation guidelines:

Small tissue specimens/biopsies (such as endoscopic biopsies, skin biopsies, endometrial curetting, etc.) should be placed in a container of 10 percent formalin.

Larger routine specimens (such as gallbladders, uteri, etc.) may be sent without fixation when specimen will be received in the Pathology Department immediately. Alternatively, they should be placed in formalin fixative when not received immediately.

Do not fix specimens requiring:

Frozen Section Diagnosis

Immediate evaluation by a pathologist

Possible bacteriologic culture

Special studies, such as lymph node, muscle biopsy, or renal biopsy

Do not place biopsy in formalin. Call 541-222-6949 to request special fixative for immunofluorescent specimens.

Submit paraffin block.

Immunoperoxidase stains – More than 100 antibodies are kept in active stock. Requests for additional antibodies can be accommodated.

Special stains are available as well, in addition to immunoperoxidase stains.

Please include clinical history, pathology report and differential diagnosis. This aids in the selection of appropriate controls for our staining procedures.

Submit paraffin block.

Immunoperoxidase stains – More than 100 antibodies are kept in active stock. Requests for additional antibodies can be accommodated.

Special stains are available as well, in addition to immunoperoxidase stains.

Please include clinical history, pathology report and differential diagnosis. This aids in the selection of appropriate controls for our staining procedures.

Specimens for bacteriologic examination must be submitted in a sterile container with a specific request for the microbiology culture. To prevent the specimen from drying, it may be necessary to add a small amount of sterile saline. Those specimens requiring both a histologic and bacteriologic workup should be routed to the tissue laboratory first and sent in with a tissue request form.

Acceptable specimen type is a vaginal swab collected with the Aptima Multitest Swab Specimen Collection Kit. Refer to the appropriate specimen collection kit package insert for specific collection instructions. After collection, swab specimens in transport tubes can be stored at 2° to 30° C for up to 30 days, or 60 days at -20° to 70° C.