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Sputum Collection

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 submitted on three to five successive mornings.

Supplies: 120 mL clean plastic specimen container; fixative (either CytoRich Red™ cytology preservative or 50% ethanol).

Collection procedures: Sputum specimens should be obtained as follows when clinically feasible. 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.

Fixation: Submit specimens fresh and unfixed if at all possible (see below).
If this is not possible then either:
1. Refrigerate specimen (4°C) or (39°F) up to 24 hours.
2. Add a equal amount of CytoRich Red™ cytology preservative to specimen.
3. Add a equal amount of 50% ethanol alcohol to specimen.
4. Submit specimen in a proprietary transport medium used for liquid based systems supplied by laboratory (e.g. Cyto-Rich RedTM, CytoLyt).

Transport: Each specimen should be placed in a clearly labeled container that is leak proof. Place specimen inside a biohazard transport bag. Paper requisition(s) 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.

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

Specimen stability: Up to 24 hours for a fresh specimen with no fixative added and refrigerated (4°C) or (39°F). Fixative added to specimen at room temperature stable indefinitely

Reference interval: By report.

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. Sputum specimens for fungi and acid-fast bacilli may also be submitted to the Microbiology or Mycology Laboratories for rapid detection procedures of these organisms.

Post-Bronchoscopy sputum: Collect one (1) 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.

CPT code(s): 88108 Concentration and interpretation; 88305 cell block. Additional CPT codes may apply if special studies are required.

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