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Sputum and bronchoscopic material Cytology

Sputum cytology examines a sample of sputum (mucus) under a microscope to determine whether abnormal cells are present. Sputum is not the same as saliva. Sputum is produced in the lungs and in the airways  leading to the lungs. Sputum has some normal lung cells in it.

Sputum cytology may be done to help detect certain noncancerous lung conditions. It may also be done when lung cancer is suspected.

A sputum sample may be collected:

  • By a person coughing up mucus.
  • By breathing in a saltwater (saline) mist and then coughing.
  • During bronchoscopy, which uses a bronchoscope to look at the throat and airway.

Sputum: Collect an early morning deep cough specimen (not just saliva) in a clean, leakproof, rigid container labeled with the patient's name and medical record number. The mouth must be rinsed out thoroughly prior to sputum collection to avoid contamination with food. Specimens must be delivered fresh to the cytology laboratory or refrigerated until delivery. NOTE: In order to assure the maximum diagnostic benefits afforded by sputum cytology, it is essential to submit early morning deep cough specimens. These should be collected for at least 3 consecutive days. The patient should be informed as to the difference between sputum and saliva and instructed to rinse out his mouth first. Outpatients may be provided with containers of fixative in which sputum is to be collected, so that they may collect the samples on 3 days and bring them in all at once without concern for degeneration. Inpatient sputum samples are to be sent fresh to the laboratory, without fixative.

Instructions to Patients for Sputum Cytology:

This is a special test which requires a fresh morning specimen of sputum, collected on three separate days. A separate container of preservative is to be used each day. THE FLUID IN THE CONTAINER IS A TOXIC SOLUTION AND IS NOT FOR HUMAN CONSUMPTION.

It is essential that you follow the simple instructions given below:

  • SPUTUM is the material from deep down in the chest and can ONLY be obtained by deep coughing.
  • SALIVA is the watery fluid in the mouth and is not desired in this test.
  • POSTNASAL DRAINAGE is the thick material, which may drain down form the nose and collect in the back of the throat, especially during the night. If this is present, it should be cleared from the throat and DISCARDED before collecting the sputum specimen.

INSTRUCTIONS:

  1. On the morning the specimen is to be collected, before breakfast, clear your throat and discard this material. IT IS ESPECIALLY IMPORTANT THAT YOU RINSE OUT YOUR MOUTH WITH WATER FIRST, IF YOU HAVE TAKEN ANYTHING BY MOUTH - such as food, milk, coffee, mouthwash, toothpaste, etc. Do not contaminate specimen with tobacco ashes, Kleenex, etc.
  2. Breathe deeply 8 to 10 times, cough deeply and expectorate into the container provide. Firmly tighten the lid and shake container vigorously for a few seconds. Collect the sputum obtained this way during the first half-hour. A small amount of sputum will be sufficient for study, IF IT HAS BEEN RAISED FROM DEEP IN THE CHEST. Do not submit a specimen unless you believe it is sputum from deep in the chest.

Instructions to Outpatient Clinic for Sputum Collection:

  1. Give the patient an instruction sheet and three containers filled with 50 ml. of the  fixative provided by cytology (Saccomanno fixative).
  2. The instruction sheet explains to the patient the method of collection.
  3. Tell the patient that he/she is to collect three separate sputum specimens at home on three consecutive days and return them to the clinic all together after the third one has been collected.
  4. Return the containers to the lab with completed pink cytology requisition forms. Be sure each container and requisition has the date of specimen collection.

SPECIAL ARRANGEMENTS FOR BRONCHOSCOPY CYTOLOGY SPECIMENS

Routine Specimen Processing

Bronchoscopy specimens (biopsies, washings, brushings) received in the Cytology Laboratory before 1530 will be processed for reading on the following workday. Specimens on inpatients arriving in Cytology after 1530 (Monday-Friday) will be processed for reading on the following workday only if the necessary laboratory personnel are available.  As many specimens as possible will be processed; however, some specimens may have to wait until the next work day for processing.  Priority will be given to the biopsy specimens. This late processing is not available on outpatient specimens. To assure next day reading (excluding weekends and holidays) of all submitted specimens, they must arrive in the Cytology Laboratory by 1530 each scheduled workday.  If requested, bronchial lavages and biopsies from inpatients that are processed on Friday by the Cytology personnel are read on Saturday morning by the appropriate resident and attending in Surgical Pathology. Results will be called to the clinician when all studies are completed.

Same Day Processing

Same day processing with interpretation is available on regularly scheduled workdays (Monday-Friday, except holidays) for bronchoalveolar lavage (BAL) and bronchial biopsy specimens ONLY for critically ill, respiratory compromised patients (e.g. immunosuppressed or transplant patients in crisis). Specimens collected on weeknights (except Friday) are sent to Central Receiving. They will be delivered and processed the following morning and read by the end of the workday.  All specimens MUST arrive in the Cytology Laboratory by 0900 in order to meet processing deadlines. Specimens that arrive after that time will be processed and read the following workday (including Saturday morning reading). The test request form should clearly indicate that Same Day Processing is required, give adequate clinical information about the patient and the specimen, and include the name of the clinician to whom the results should be reported as well as a PIC number or extension where he/she can be reached.

Weekend/Holiday Processing

Bronchoalveolar lavage specimens from critically ill, respiratory compromised patients obtained on weekends (1700 Friday through 0700 Sunday) or on certain holidays will be processed and read by the Anatomic Pathology resident on call.  Only specimens that are collected on a day followed by a CLOSED day in the Cytology Laboratory (e.g., Saturday, holiday weekends) will be processed by the resident. Specimens collected on a day followed by an OPEN day in Cytology (e.g. Sunday) will NOT be processed by the resident.  They will be handled by the Cytology staff on the following workday (refer to instructions for same day processing previously discussed).

The clinician performing the bronchoscopy should notify the Anatomic Pathology resident on call (PIC 1264) as soon as the decision to do the procedure is made regardless of when the procedure will actually be performed.  This will allow the resident to make the necessary arrangements for the processing and interpretation of the material.  After the specimen is collected, it should be delivered directly to the Anatomic Pathology resident.  Do NOT deliver the specimens to Central Receiving unless directed to do so by the Anatomic Pathology resident.

Each specimen must be accompanied by a separate test request form with complete patient information and clinical data recorded on it.  The form should also indicate the name of the clinician to whom the results should be reported and a PIC number or extension where he/she can be reached.  Results on all specimens will be telephoned to the appropriate clinician as soon as all studies are completed.

Bronchial biopsy specimens are NOT typically processed on weekends and holidays. They will be handled by the Cytology Laboratory staff on the next scheduled workday (refer to instructions for same day processing). However, they can be processed in cases of extreme critical need. Discuss the case with the AP Resident on-call (PIC 1264).

Health Tips 

what is sputum cytology ?

Sputum cytology examines a sample of sputum (mucus) under a microscope to determine whether abnormal cells are present. Sputum is not the same as saliva. Sputum is produced in the lungs and in the airways camera.gif leading to the lungs. Sputum has some normal lung cells in it.

Sputum cytology may be done to help detect certain noncancerous lung conditions. It may also be done when lung cancer is suspected.

A sputum sample may be collected:

By a person coughing up mucus.
By breathing in a saltwater (saline) mist and then coughing.
During bronchoscopy, which uses a bronchoscope to look at the throat and airway.

Why It Is Done ?

Sputum cytology is done to find:

Lung cancer. But sputum cytology is not used as a screening test for people at risk for developing lung cancer, such as smokers.
Noncancerous lung conditions, such as pneumonia or inflammatory diseases, tuberculosis, or the buildup of asbestos fibers in the lungs (asbestosis).

How To Prepare ?

Home or office sample

No special preparation is required if the sputum sample is to be collected at home or in your doctor's office.

Bronchoscopy sample

Before you have bronchoscopy to collect a sputum sample, tell your doctor if you:

Are taking any medicines.
Have allergies to any medicines, including anesthetics.
Have any bleeding problems or take blood thinners, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin).
Are or might be pregnant.
If you have a bronchoscopy, you will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean.
Your doctor will tell you how soon before the procedure to stop eating and drinking. Follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
Arrange to have someone drive you home after the procedure.

How It Is Done ?

Home or office sample

Three sputum samples are usually collected over 3 days. Your doctor will give you a container to collect the sputum. This container may have a small amount of liquid (called fixative) in it. The fixative helps preserve the sample. Do not drink this liquid.

For best results, collect the sample in the morning right after waking up. Follow these steps:

If you wear dentures, remove them before collecting the sample.
Rinse your mouth with water.
Take about four deep breaths followed by a few short coughs, then inhale deeply and cough forcefully into the container. Sputum is not the same as saliva, so make sure to get a sample of mucus from deep in your airway. Collecting the sample in the morning, when you first wake up, is generally best.
If you have trouble obtaining a good sample, try taking a hot shower first to help loosen the mucus in your airway.
Carefully follow your doctor's instructions about where to deliver the sample. You may be instructed to take the sample to the doctor's office or to a laboratory. Deliver the sample soon after you obtain it. You may be instructed to refrigerate the sample if you are not able to deliver it immediately.

Bronchoscopy sample
During bronchoscopy, a thin, lighted instrument (bronchoscope) is inserted through the nose or mouth into the throat and then into the airways leading to the lungs. To learn more about how the procedure is done, see the topic Bronchoscopy.

How It Feels

Home or office sample
If you have discomfort when taking a deep breath or coughing, getting a sputum sample may be uncomfortable.

Bronchoscopy sample
You may be able to feel pressure in your airway as the bronchoscope is moved from place to place. You may gag or cough. If you have general anesthesia, you will feel nothing during the procedure. To learn more about how the procedure feels, see the topic Bronchoscopy.

Risks

Home or office sample

There is no risk linked with collecting a sputum sample at home or at your doctor's office.

Bronchoscopy sample

Bronchoscopy is generally a safe procedure. Although complications are rare, you should discuss the risks in your particular case with your doctor. Complications that may occur include:

Spasms of the bronchial tubes. These can impair breathing.
Irregular heart rhythms (arrhythmias).
Infection, such as pneumonia. These usually can be treated with antibiotics.

Results

Sputum cytology examines a sample of sputum (mucus) under a microscope to determine whether abnormal cells are present. It may take several days to receive results from a sputum cytology.

Sputum cytology
Normal:
Normal lung cells are present in the sputum sample.

Abnormal:
Abnormal cells are present in the sputum sample. Abnormal cells may mean lung conditions such as pneumonia, inflammation, the buildup of asbestos fibers in the lungs (asbestosis), or lung cancer.

What Affects the Test ?

Reasons you may not be able to have the test or why the results may not be helpful include a sample that is too small; is dried out; contains only saliva; or is from nasal secretions, not your airway.

What To Think About

There is a chance of false-negative test results with sputum cytology. This means that the test shows a lung condition is not present when it actually is present. Follow-up testing may need to be done if your symptoms continue.
A sputum culture is a test to find and identify bacteria or fungi that are infecting the lungs or breathing passages. It is also done to identify the best antibiotic to treat a lung infection. To learn more, see the topic Sputum Culture.
Bronchoscopy or a needle lung biopsy are more commonly used than sputum cytology because the results provide more information about airway problems.

What is Bronchoscopy ?

Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. During a bronchoscopy camera.gif, your doctor will examine your throat, larynx camera.gif, trachea camera.gif, and lower airways.

Bronchoscopy may be done to diagnose problems with the airway, the lungs, or with the lymph nodes in the chest, or to treat problems such as an object or growth in the airway.

There are two types of bronchoscopy.

Flexible bronchoscopy uses a long, thin, lighted tube to look at your airway. The flexible bronchoscope is used more often than the rigid bronchoscope because it usually does not require general anesthesia, is more comfortable for the person, and offers a better view of the smaller airways. It also allows the doctor to remove small samples of tissue (biopsy).
Rigid bronchoscopy is usually done with general anesthesia and uses a straight, hollow metal tube. It is used:
When there is bleeding in the airway that could block the flexible scope's view.
To remove large tissue samples for biopsy.
To clear the airway of objects (such as a piece of food) that cannot be removed using a flexible bronchoscope.

Why It Is Done ?

Bronchoscopy may be used to:

Find the cause of airway problems, such as bleeding, trouble breathing, or a long-term (chronic) cough.
Take tissue samples when other tests, such as a chest X-ray or CT scan, show problems with the lung or with lymph nodes in the chest.
Diagnose lung diseases by collecting tissue or mucus (sputum) samples for examination.
Diagnose and determine the extent of lung cancer.
Remove objects blocking the airway.
Check and treat growths in the airway camera.gif.
Control bleeding.
Treat areas of the airway that have narrowed and are causing problems.
Treat cancer of the airway using radioactive materials (brachytherapy).

How To Prepare ?

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will mean. To help you understand the importance of this procedure, fill out the medical test information form(What is a PDF document?).

Before you have a bronchoscopy, tell your doctor if you:

Are taking any medicines.
Are allergic to any medicines, including anesthetics.
Have had bleeding problems or take blood-thinners, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin).
Are or might be pregnant.
Your doctor will tell you how soon before the biopsy to stop eating and drinking. Follow the instructions exactly about when to stop eating and drinking, or your test may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.

Your doctor may order other tests before your bronchoscopy, such as a complete blood count (CBC), clotting factors, arterial blood gas (ABG), or lung function tests.

Arrange to have someone drive you home after the procedure.

How It Is Done ?

You may be asked to remove dentures, eyeglasses or contact lenses, hearing aids, wigs, makeup, and jewelry before the bronchoscopy procedure. You will empty your bladder before the procedure. You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the procedure). You will be given a cloth or paper covering to use during the procedure.

The procedure is done by a pulmonologist and an assistant. Your heart rate, blood pressure, and oxygen level will be checked during the procedure.

A chest X-ray may be done before and after the bronchoscopy.

Flexible bronchoscopy

During this procedure, you will lie on your back on a table with your shoulders and neck supported by a pillow, or you will recline in a chair that resembles a dentist's chair. Sometimes the procedure is done while you are sitting upright.

You will be given a sedative to help you relax. You may have an intravenous line (IV) placed in a vein. You will remain awake but sleepy during the procedure.

Before the procedure, your doctor usually sprays a local anesthetic into your nose and mouth. This numbs your throat and reduces your gag reflex during the procedure. If the bronchoscope is to be inserted through your nose, your doctor may also place an anesthetic ointment in your nose to numb your nasal passages.

Your doctor gently and slowly inserts the thin bronchoscope through your mouth (or nose) and advances it to the vocal cords. Then more anesthetic is sprayed through the bronchoscope to numb the vocal cords. You may be asked to take a deep breath so the scope can pass your vocal cords. It is important to avoid trying to talk while the bronchoscope is in your airway.

An X-ray machine (fluoroscope) may be placed above you to provide a picture that helps your doctor see any devices, such as forceps to collect a biopsy sample, that are being moved into your lung. The bronchoscope is then moved down your larger breathing tubes (bronchi) to examine the lower airways.

If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or brush will be used through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab to be studied.
Finally, small biopsy forceps may be used to remove a sample of lung tissue. This is called a transbronchial biopsy.

Rigid bronchoscopy

This procedure is usually performed under general anesthesia. You will lie on your back on a table with your shoulders and neck supported by a pillow.

You will be given a sedative to help you relax. You will have an intravenous line (IV) placed in a vein. Once you are asleep, your head will be carefully positioned with your neck extended. A tube (endotracheal) will be placed in your windpipe (trachea) and a machine will help you breathe. Your doctor then slowly and gently inserts the bronchoscope through your mouth and into your windpipe.

If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or a brush will be inserted through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab for biopsy.

Recovery after bronchoscopy

Bronchoscopy by either procedure usually takes about 30 to 60 minutes. You will be in recovery for 1 to 3 hours after the procedure. Following the procedure:

Do not eat or drink anything for 1 to 2 hours, until you are able to swallow without choking. After that, you may resume your normal diet, starting with sips of water.
Spit out your saliva until you are able to swallow without choking.
Do not drive for at least 8 hours after the procedure.
Do not smoke for at least 24 hours.

How It Feels

If you have general anesthesia, you will feel nothing during the procedure. Oxygen is usually given through a small tube placed in your nose if you are awake during the procedure.

You may be able to feel pressure in your airway as the bronchoscope is moved from place to place. You may gag or cough during bronchoscopy. Your airway will not be blocked, but if you feel discomfort let your doctor know.
After the procedure, you may feel tired for a day or so and have general muscle aches. If a local anesthetic is used, you may have a bitter taste in your mouth. Your mouth may feel very dry for several hours after the procedure. You may also have a sore throat and some hoarseness for a few days. Sucking on throat lozenges or gargling with warm salt water may help soothe your sore throat.

The anesthesia will make it hard to swallow. You will need to avoid eating or drinking for 1 to 2 hours after the procedure.

If a biopsy sample was taken, it is normal to spit up a small amount of blood after the procedure.

Risks

Bronchoscopy is generally a safe procedure. Although complications are rare, your doctor will discuss any risks with you. Complications that may occur include:

Spasms of the bronchial tubes, which can impair breathing.
Irregular heart rhythms (arrhythmias).
Infections, such as pneumonia. These can usually can be treated with antibiotics.
Ongoing hoarseness.
If a biopsy was done during bronchoscopy, complications that may occur include:

A tear in the lung from the biopsy forceps used to collect a tissue sample. This will allow air to flow into the pleural space, producing a partial collapse of the lung (pneumothorax).
Bleeding caused by the biopsy forceps used to collect the tissue.
An infection from the biopsy procedure.
A very small chance of death.

Results

Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. Your doctor may discuss your results with you soon after the procedure. Test results on any biopsy samples are usually available in 2 to 4 days.

Bronchoscopy
Normal:
The large airway leading to the lungs and the breathing tubes in the lungs appear normal. There are no objects, thick secretions, or growths.

Abnormal:
An object, thick secretions, or growths are blocking your airway.
Tissue sample shows a lung infection or disease, such as tuberculosis or lung cancer.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

A problem that limits your ability to extend your neck.
A biopsy sample that is too small for a diagnosis.
Also, a biopsy collects tissue from such a small area, so there is a chance that a cancer may be missed.

What To Think About

Before a final diagnosis is made, the results of a bronchoscopy will be considered along with your medical history, physical examination, and the results of other tests including a chest X-ray or a computed tomography (CT) scan. A lung biopsy may be needed when all of these other results are inconclusive.
Chest X-Ray
CT Scan of the Body
Lung Biopsy
A needle biopsy with a CT scan is commonly used because it can diagnose many lung problems. A bronchoscopy may be a better option when the problem is close to the airway. Your doctor will determine the best method for you.
Virtual bronchoscopy uses a CT scan to provide a picture of the throat and airways. It does not require the placement of a bronchoscope down the throat.
Bronchoscopy methods that use ultrasound and other technologies can help diagnose and treat more problems than standard bronchoscopy. But these methods may not be available everywhere.