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.
Specimen Required: Minimum 5 mL (> 5 mL if possible) of sputum obtained from a deep cough specimen.
Supplies: Clean plastic specimen container; fixative (Saccomanno fixative)
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.

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: We 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 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.
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).
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).
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.

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).
Specimen Required: Bronchoscopically-obtained lavage (preferably at least 20 mL) of the distal airway and alveoli in the distribution of the suspected lesion.
Supplies: Standard bronchoscopy. 120 mL clean plastic specimen containers.
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 form. 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.

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.
NOTE:  For the interpretation of BAL specimens, relevant clinical information must be provided.