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Oral Brushings

Test indication: Detection and characterization of malignancy and infectious processes in the oral cavity.

Methodology: Routine cytopathology evaluation.
Performed: Monday-Friday.
Reported: 1 day (unless special studies are required).

Specimen required: Brushing sample of the identified lesion.

Supplies: One 5 to 10 mL vial or specimen container of sterile normal saline or fixative. (CytoRich Red™ cytology preservative or 50% ethanol).

Collection procedure: Identify the lesion in question and obtain a brushing sample of the lesion.
Note: It is important to brush the edges of an ulcer, as well as the floor, in order to obtain diagnostic material. Agitate the brush vigorously in a 5 to 10 mL vial of saline or fixative. DO NOT APPLY THE BRUSH DIRECTLY TO SLIDES. If possible, detach the brush and leave it in the fixative vial/container. Label the vial with patient’s first and last name, date of birth and specimen source. Submit specimen along with the completed test request form to the Cytopathology Laboratory. The specimen should be submitted in fixative if transport of the specimen will be delayed more than 4 hours. If transport time will be less than four hours or if fixative is not available the specimen should be refrigerated or kept on wet ice until transport to the lab.

Fixation: The slide(s) should be fixed immediately. Immediate fixation of a 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 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 alcohol it may remain in the alcohol for transport for to the laboratory or alternatively the specimen can be immersed in alcohol 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: Fresh specimen is stable for 4 hours. Fixed slides are stable indefinitely. Liquid preservative up to 72 hours, fresh refrigerated specimen stabilty varies. If transport time will be less than 24 hours, or fixative is not available, the specimen should be refrigerated (4°C or 39°F) or kept on wet ice until transport to the Cytopathology Laboratory.

Reference interval: By report.

CPT code(s): Depending on collection method: 88108 Concentration and interpretation or 88112 Selective cellular enhancement with interpretation or 88104 Smears with interpretation. Additional CPT codes may apply if special studies are required.

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