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Patient Prep: 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. For bronchoalveolar lavage specimens, refer to Cytology, Bronchoalveolar Lavage Specimen Collection.
Collect: Sputum
Indications: For the detection and characterization of premalignant/malignant pulmonary lesions.
Specimen Required: 5 mL (about one teaspoon) or more if possible, of sputum obtained from a deep cough specimen.
Supplies: 120 mL clean plastic specimen container; fixative (either Saccomanno fixative or 50% ethyl alcohol).
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. Specimen should be a deep cough specimen and not saliva. Saliva is of no diagnostic value. If transport of the specimen will be delayed more than 24 hours, add 50 mL of Saccomanno fixative or 50% ethyl alcohol. 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 the patient's first and last name, date of birth, and specimen source. Submit the specimen, along with the completed test request form to the Cytopathology Laboratory.
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. The Cytopathology Laboratory will not accept induced or any other sputum samples for the cytologic detection of Pneumocystis, fungi or acid-fast bacilli. If a bronchoalveolar lavage cannot be obtained, the preferred methodology for detection of Pneumocystis is by fluorescent antibody testing performed in the ARUP Infectious Disease Laboratory. Sputum specimens for fungi and acid-fast bacilli may also be submitted to the Infectious Disease Laboratory for rapid detection procedures of these organisms.
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 test request form.
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 (or more if necessary) 5 to 10 mL vial or tube of sterile normal saline or fixative (either Saccomanno fixative or 50% ethyl alcohol).
Collection Procedure: Using standard bronchoscopy technique, identify the lesion in question and obtain a brushing sample of the lesion. Upon withdrawing the brush, agitate the brush vigorously in a 5 to 10 mL vial of sterile saline or fixative. DO NOT APPLY THE BRUSH DIRECTLY TO SLIDES. If possible, detach the brush and leave it in the vial. Label the vial with patient's first and last name, date of birth, and specimen source. Submit the specimen along with the completed Cytology test request form to the Cytopathology Laboratory. If transport of the specimen will be delayed more than four hours, the specimen should be submitted in Saccomanno fixative or 50% ethyl alcohol. If transport time will be less than four hours, or fixative is not available, the specimen should be refrigerated or kept on wet ice until transport to the lab.
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 or Pneumocystis).
Specimen Required: Bronchoscopically-obtained washing (10 mL is preferred) of the bronchi in the region of the suspected lesion.
Supplies: Standard bronchoscopy equipment. 120 mL clean plastic specimen container(s). Fixative (either Saccomanno fixative or 50% ethyl alcohol).
Collection Procedure: Using standard bronchoscopy technique, lavage the distribution of the bronchus to be sampled. Collect the wash in a clean container. Label the container with patient's first and last name, date of birth, and specimen source. Submit the specimen, along with the completed Cytology test request form to the Cytopathology Lab. If transport of the specimen will be delayed more than 24 hours, add 50 mL of Saccomanno fixative or 50% ethyl alcohol. 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.
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