Breast/nipple Discharge

Test indication: Detection of malignant cells in nipple discharge specimen.

Specimen type: Direct smear of nipple discharge.

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

Specimen requirement: Direct smear of nipple discharge.

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

Collection 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. Collect a small amount of nipple secretion directly onto one of the slides. 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.

Fixation: The slide 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:
1. Immersion: Place the smear into 95% ethanol. If the specimen is immersed in alcohol, it may remain in the alcohol for transport 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.
2. 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 containers 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 Department.

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.

Reference interval: By report.

CPT code(s): 88104 smears and interpretation

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