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Sentinel Lymph Node Touch Preparation and Evaluation - Cytology, Royal Oak

Sentinel lymph node, Axillary lymph node - touch prep, Sentinel breast biopsy - touch prep, Axillary biopsy - touch prep, Lymph node - touch prep, Cytology, non-gyn lymph node, Sentinel lymph node - scraping, CYTOLOGY, MEDICAL NON-GYN

Test Codes

EPIC: LAB6797

Department

Cytology

Instructions

Cytology Laboratory staff should be notified that the sentinel node is being delivered at 248-898-9035 (extension 89035).

Specimen Collection Criteria

Collect: Submit unfixed sentinel lymph node specimens for intraoperative cytologic evaluation directly to the Cytology Laboratory in individual specimen containers.

• A maximum of 5 nodes will be evaluated under most circumstances.
  • Current available published data indicates that patients undergoing sentinel lymph node mapping should have a maximum five sentinel lymph nodes evaluated. Each sentinel lymph node evaluation in an intraoperative setting requires an additional 15 minutes to process and interpret.
  • The surgeon should prioritize which lymph nodes they wish evaluated otherwise the first five lymph nodes will be processed.
  • If the surgeon wishes all nodes to be evaluated, they must call the cytopathologist directly (248-898-9035) and request that the additional sentinel lymph nodes also be processed.
  • For patients undergoing immediate reconstruction with TRAM flap reconstruction, all sentinel lymph nodes will be evaluated.

• Each sentinel lymph node container should be labeled with the patient's full name, date of birth, medical record number, date of test, test ordered, specimen source (i.e. right axillary) and numbered.
• In house cytology specimens should be ordered in EPIC Specimen Navigator “CYTOLOGY, MEDICAL NON-GYN” and fill in all appropriate fields. Label specimen containers with EPIC specimen labels and submit with requisition which must include the patient name, medical record and visit/CSN number, date of birth, date of specimen collection, source of specimen, patient history and ordering physician/surgeon’s name. Place EPIC specimen label on requisition.

Physician Office/Draw Specimen Preparation

Arrange for transportation to the Cytology Laboratory prior to specimen collection. Maintain specimens at room temperature (20-26°C or 68-78.8°F) prior to transport.

Preparation for Courier Transport

Transport: Sentinel Lymph Nodes in individual specimen containers, at room temperature (20-26°C or 68-78.8°F).

Rejection Criteria

• Improper labeling of specimen container or requisition.
• Specimen not accompanied by requisition.
• Requisitions not accompanied by a specimen.
• Improper collection of specimen (such as improper fixation).
• Any specimen received without all the required information can result in a delay of processing until all information can be verified.

Inpatient Specimen Preparation

Deliver the specimen directly to the Cytology Laboratory (north tower, lower level, west wing of the Royal Oak Hospital) Monday – Friday 7:30 am – 4:30 pm immediately after collection.

In-Lab Processing

• Cytopathologist dissects, bisects and scrapes each sentinel lymph node and these specimens are stained immediately for microscopic evaluation.
• The Cytopathologist will call the surgeon with the results. A written Cytopathology report will be issued within 24 hours post evaluation.
• The Sentinel Lymph Nodes are fixed in formalin and delivered to Surgical Pathology after the Cytopathologist has contacted the surgeon.

Storage

Specimen Stability for Testing:

Fresh Tissue
Room Temperature (20-26°C or 68-78.8°F): Specimens are tested immediately upon receipt in the Laboratory.
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

Specimens are fixed in formalin and stored in the Histology Laboratory for four weeks at room temperature (20-26°C or 68-78.8°F).

Laboratory

Royal Oak Cytology Laboratory

Performed

Test Methodology

Intraoperative reading of touch preparation of fresh tissue.

CPT Codes

CPT: 88333, 88334.
LOINC: 33716-2.

Contacts

Last Updated

9/27/2022