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Brushing(s)

Test indication: For the detection and characterization of visible premalignant/malignant lesions; for the identification of some microbiologic pathogens (primarily viral and fungal).

Specimen types: Brushing specimens may be taken from any surface of the body including, but not limited to, the following sites: Gastrointestinal tract, Larynx, Nasopharynx, Oral Cavity, Paranasal sinus, Prostate, Respiratory tract and Trachea.

Methodology: Routine cytopathologic evaluation.
Monday-Friday.
TAT: Performed:1 day.

Specimen requirement: Direct brush sampling of identified lesion.

Supplies: Two clean glass slides (single-end frosted), fixative (spray fixative, 95% ethanol, 50% ethanol, Saccomanno or proprietary transport medium, test requisition form, biohazard bag, slide mailer or clean non-sterile leak proof container.

Collection procedure: Using standard technique, identify the lesion in question and obtain a brushing. 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 directly to the slides.

If possible, detach the brush and leave it in the vial/container of fixative (either CytoRich Red™ cytology preservative, 50% ethanol or proprietary transport medium). The brush may be submitted in the 50% ethanol equal to the volume of the specimen or in a proprietary transport medium supplied by manufacturers of liquid based systems. The brush may be submitted in the solution or discarded after vigorously removing the adherent cellular material into the medium. The container must be clearly labeled with the patient’s name. The container should be leak proof with enough fluid to cover the brush if submitted.

If direct smears are prepared prior to the procedure label the two slides with the patient’s first and last name, date of birth and specimen site in pencil on the frosted end. Oppose a second glass slide onto the first, allowing the collected material to provide surface tension between the two slides, and then gently and quickly pull the two slides apart in a horizontal motion to distribute the material in a thin film over both slides. Alternatively, air-dried brushing smears may be submitted for staining with one of the Romanowsky stains or for rehydration prior to Papanicolaou staining. Mark smears clearly indicating they are air-dried.

Fixation: The slide(s) should be fixed immediately. Immediate fixation of cellular sample is necessary to prevent air-drying which obscures cellular detail and compromises specimen evaluation. Fixation can be done by detaching the brush and leaving it in the vial/container of liquid transport medium (CytoRich Red™ cytology preservative, 50% ethanol or proprietary transport medium). The brush may be submitted in the 50% ethanol equal to the volume of the specimen or in a proprietary transport medium supplied by manufacturers of liquid based systems.

Immersion: Place the smear(s) into 95% ethanol. If the specimen is immersed in ethanol, it may remain in the ethanol for transport to the laboratory or alternatively the specimen can be immersed in ethanol for 20-30 minutes, removed and allowed to air dry,
then placed in a container/mailer to be transported to the laboratory.

Spray fixation: If spray fixed, only quality controlled cytology fixative should be used. The manufacture’s instructions should be followed. Hold spray 6-10 inches (15-25 centimeters) from the glass slide when applied.

Transport: Fixed smears should be submitted in slide mailer(s), clearly labeled with patient name and specimen site(s). Slides in fixative should be submitted in leak proof container(s) that protect against breakage and clearly labeled with patient name and specimen site(s). Paper requisitions that accompany the specimen or slides in fixative should be placed in the outside pocket of the biohazard bag to avoid exposure to any leakage of fixative. Submit the specimen and the completed test request form to the Cytopathology Laboratory.

Causes for rejection: Incomplete patient requisitions, unlabeled/incorrectly labeled specimen, frozen specimen, incorrect test ordered for specimen, specimen submitted in incorrect or expired fixative, specimen from unauthorized person.

Specimen stability: Fixed slides: Indefinitely. Liquid preservative up to 72 hours, fresh refrigerated specimen time varies. If transport time will be less than 24 hours or fixative is not available, the specimen should be refrigerated at 4°C (or 39°F) or kept on wet ice until transport to the lab.

Reference interval: By report

CPT code: 88104 smears with interpretation.

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