1-1 Cytopathology Personnel, Procedures and Policies

From MGH Learn Pathology

Lectures

Cytopathology Laboratory

  • Location: Warren 125 (6-3980) – Main Cytology Office: supervisor’s office, cytotechnologists’ stations, cytopathology fellow desks (4-1422), secretaries and multi-headed microscope
  • Warren 113 (4-1424) – Cytology Specimen Preparation Room: specimen drop off
  • Wang 270-FNA exam room (4-1077)
  • Wang 290- FNA waiting room on ACC-2
  • Staff:
  • Cytopathologists:
  • Cytotechnologists - Peter Brown, Heather Grant, Diane Kuebler, Marilyn Nutter, Mary Pinheiro-Rego, Lisa Ring, and Caitlin Eno
  • CLA Secretaries – Bernadette Femino and Diane White
  • Lab Preparatory Technologists - Ernest Li, Shirley

Hours of Operation:

  • The Cytopathology Laboratory is open Monday through Friday:
    • For reports and information: 8:30 a.m. - 5:00 p.m.
    • For specimen preparation: 7:30 a.m. – 5:00 p.m.
  • After Hours Policy

Services Offered

  • Diagnostic interpretation of cytology specimens:
  • Fine needle aspiration biopsy (FNAB) service:
  • Rapid Evaluation and Interpretation (Rapids):

Critical Values for Cytopathology

1. The pathologist (or nominated designee) will transmit a result urgently to the attending physician or another licensed caregiver who can take action on the results, ideally by telephone, under the following general circumstances:
2. The following case types constitute a critical value in cytology:


  • To document notification, insert Coded Comment: “NOTIFY”[F8}
  • To flag the case as a critical value case, check the
  • Retrieval Flag: CVR [critical value report]
  • GYN cases: staff/reflex tab
  • Non-GYN case: QA tab

Cytology Specimens

Specimen types:

Gynecologic (Pap smears):
Non-gynecologic:

Specimen Collection

Cytology test orders are only accepted from individuals authorized to do so in accordance with law and regulation.

  • Gyn specimens (Pap smears):
  • Non-gyn specimens:

Specimen Delivery

  • Between 7:30 a.m. and 5:00 p.m. (Monday through Friday), specimens should be delivered to the cytopreparatory laboratory area (Warren 113). When the laboratory is closed, specimens should be taken to the Core lab on Gray 5 between the hours of 5 p.m.-7:30 a.m. Monday-Friday and on weekends/holidays.
  • Verbal Orders:

Specimen Rejection Policy

Specimens received in the Cytopathology Laboratory having identification information that cannot be verified will not be processed. Two patient identifiers must be provided and verified as correct before laboratory specimens will be processed or tested. Both container or slides and requisition must be labeled. The labels must contain the patient’s full name and/or medical record number and/or date of birth. Identifiers must match one another. Specimens that are not readily replaced and have identification discrepancies will be processed upon completion of a Specimen Release form and corrected requisition by an individual authorized to take such responsibility. (See cytology manual for complete procedure).

Rapid on site evaluation and interpretation

  • Rapid interpretations are performed on most FNABs performed by the pathologist or other physicians (radiologist, gastroenterologist, pulmonologist, surgeon) in order to guide the procedure. The rapid is intended to assess if the specimen is representative, to determine the need for additional passes and to correctly triage the material for special studies if need be (flow cytometry, cultures, electron microscopy or a request for core biopsy by the radiologist). A definitive diagnosis is not necessary at the time of rapid interpretation although this may be possible in many cases.
  • For radiologically obtained FNABs, a cytotechnologist selects one smear per pass, stains the smear with H&E and evaluates the smear. When the tech estimates that the smear is representative, the pathologist is called to give the rapid interpretation.
  • Rapid interpretations of previously submitted specimens or specimens obtained by the clinician will be performed only if the rapid interpretation will affect current patient care.
  • Please send ALL specimens from the procedure for each patient to cytology at the same time to avoid delays in processing.

FNA Tissue Triage For Radiologically Guided CT/US Guided Biopsies

Perform FNA first
Perform core biopsy second

Tissue Triage for EBUS Procedures

Brushing
Bronchial wash and lavage
EBUS-FNAB (do not need rapid interpretation if doing a concurrent frozen section of core biopsy)

Cytology service page