©American
Society for Veterinary Clinical Pathology |
Principles of Quality Assurance and Standards
for Veterinary Cytology
I. Preanalytical Factors Important in Cytology
II. Analytical Factors Important in Cytology
III. Postanalytical Factors Important in Cytology
I. Preanalytical Factors Important in Cytology [Return to Top]
A. Specimen Collection
Appropriate specimens should be submitted. Identification of the site and method of collection is of great importance in determining optimal preparation and in interpretation. The cytologist or cytopathologist should be knowledgeable about the effects of differing methods of collection with regard to expected cytologic features and interpretation.
B. Specimen Handling
The specimen should be submitted in appropriate container and physical form, as determined by the type of specimen, available techniques and laboratory instructions (such as prepared smears on slides or liquids with or without anticoagulants). Instructions for collection, slide preparation, and specimen fixation (if pertinent) should be made available to clients in a laboratory services manual, special information sheets, journal or newsletter articles, other written material or by telephone conversation.
C. Specimen Transport
Specimen delivery to the laboratory should be timely with regard to the type of specimen and its stability.
D. Specimen Identification
Specimens should be identified with pertinent information as determined by the laboratory (such as location from which the specimen was collected, method of collection, fixed or unfixed, owner, species, animal signalment, name of clinic or doctor, address, telephone and fax numbers, e-mail address, etc.) on the sample container and submission form.
C. Test Identification
The requested test(s) should be clearly stated on the submission form.
D. Specimen Accessioning
The specimen should be correctly entered into the laboratory system. Test request entry, delivery of the specimen to the correct location, and specimen aliquoting (if necessary) or sharing between laboratories or departments (ie, microbiology and cytology) should be coordinated.
E. Client Communication and Education
Communication between laboratory personnel and clients should be timely and courteous regarding pre-analytical factors influencing laboratory test results (eg, incomplete submission forms, inappropriate sample or sample handling or poor sample quality). Clients should be informed of the expected time for receipt of preliminary and final reports.
F. Personnel Safety
Personal protective equipment should be appropriate for handling specimens and equipment used for cytology. Safety procedures and disposal of all samples and supplies should be appropriate for the type of specimen. Personnel should receive safety and biohazard training and information about exposure to potentially hazardous chemicals or infectious agents. All training should be documented.
G. Laboratory Environment
The laboratory space should be clean, well lit, and organized to ensure proper achievement of the above goals.
H. Personnel Requirements
Laboratories should have adequate, trained staff with skills in specimen handling and sample preparation and sufficient time for cytologic preparation of specimens, data entry of results and completion of their other workload. Documentation of training, continuing education, and proficiency assessment should be at the discretion of the laboratory director and/or certifying or accrediting agencies.
II. Analytical Factors Important in Cytology [Return to Top]
A. Quality Control (Return to Top)
Quality control should be appropriate for the types of specimens, stains and procedures included as part of cytology preparation and analysis. These may vary with each laboratory, type of cytology preparation, and the preferences of the cytopathologist. All equipment should be clean, maintained according to manufacturer’s specifications and properly operated to ensure high quality preparations.
B. Laboratory Personnel Knowledge (Return to Top)
Laboratory personnel should have knowledge of common problems encountered in sample preparation and have the ability to troubleshoot procedures for problem resolution.
C. Expertise in Specimen Analysis (Return to Top)
1. The individual interpreting veterinary specimens should be an experienced cytologist, preferably a veterinary pathologist, with knowledge of cytologic findings from a wide variety of species and specimens types.
2. Appropriate avenues should exist for a second opinion or additional review or consultation with a cytologist or pathologist, if needed or requested.
3. Attempts to help determine diagnostic accuracy should be pursued. These may include:
(a) Correlation of findings with histologic or additional cytologic specimens.
(b) Follow-up information regarding the animal’s conditions an/or responses to therapy.
(c) Review of selected cytologic specimens by the same or another cytologist or cytopathologist to determine if there are features that have been overlooked, overinterpreted, or underinterpreted.
(d) Correlation with other types of testing or diagnostic methods, eg, radiography, ultrasound, microbiologic culture, etc.)
4. The cytologist/cytopathologist should have adequate knowledge of the appropriate use of resources and decisions regarding the need for additional or special preparations, specimen adequacy, etc.
5. The cytologist/cytopathologist should review and interact with laboratory personnel concerning technical aspects of sample handling and processing.
6. The cytologist/cytopathologist should be able to communicate with and educate clients concerning important preanalytical, analytical and postanalytical factors. These may include:
(a) Information about specimen adequacy
(b) Suggested modifications of techniques
(c) Additional testing options
(d) Diagnoses or differential diagnoses
(e) Prognosis or monitoring
(f) Treatment recommendations at a level based on experience or knowledge of treatment options
7. If the cytologist/cytopathologist is not experienced in treatment, consultation with a specialist may be arranged.
Postanalytical Factors Important in Cytology [Return to Top]
A. Computer Entry of Data/Transcription
Reports should be accurate whether created manually or by transcription and in a standard format as established by the laboratory. Reports should meet established laboratory standards for uniform reporting.
B. Report Generation
Reports should be in a format that is readable and easily understood, with appropriate references or explanations as needed. They should be generated in a timely manner relative to preanalytical and analytical components.
C. Report Delivery
Report delivery should be timely, to the correct client, and in a manner agreed upon by the client and the laboratory.
D. Specimen Storage
Specimens should be stored under appropriate conditions for a predetermined time, as determined by laboratory policy and/or certification/accreditation requirements.
E. Specimen Disposal
Laboratories should appropriately dispose of biohazardous and non-biohazardous materials and specimens, including timely emptying of all containers and trash bins.
F. Personnel Safety
Conditions should be appropriate for data entry, transcription, handling of specimens, specimen disposal and all other postanalytical tasks.
G. Laboratory Environment
The laboratory environment should meet standard requirements necessary for safe, rapid, efficient and effective performance.