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Test Code Pathology Gyn Request, Female Genital Tract Cytology, Female Genital Tract

Important Note

To order in Cerner place a Pathology Gyn Request and follow prompts.

Performing Laboratory

Memorial Hospital Laboratory- Cytology Laboratory 304-388-5562

Patient Preparation

  1. Ideal testing date is 2 weeks after first day of last menstrual period.
  2. Discourage testing during normal menses.
  3.  Avoid use of vaginal medication, vaginal contraceptives, or douches for 48 hours prior to examination.

Required Information

Cytology Request Form

  1. Patient’s name
  2. Date of birth
  3. Patient address, phone number, and insurance information
  4. Date of collection
  5. Source of material (cervical, endocervical, vaginal)
  6. Check box for 1 of the following: Screening (low risk), Screening (high risk), Diagnostic
  7. Number of slides submitted
  8. Physician’s name and phone number

Clinical Information

  1. Date of last menstrual period
  2. Hormonal status (eg, postmenopausal, pregnant)
  3. Exogenous hormone therapy (including BCPs, treatment for endocrine responsive malignancy, estrogen creams)
  4. Presence of IUD
  5. DES exposure
  6. History of cervical intraepithelial neoplasia, cervical malignancy, or any extragenital malignancy
  7. History of systemic chemotherapy
  8. History of pelvic radiotherapy
  9. History of gynecologic surgery, cryosurgery, electrocautery, or laser surgery
  10. Date of last gynecological smear and history with dates of any previous abnormal histology or cytology reports
  11. Any current abnormal findings or patient complaints
  12. High-risk factors for cervical cancer (eg, sexually transmitted diseases, sexual activity at an early age, number of pregnancies, if obtainable, and smoking)

Specimen Requirements

Thin Prep

The specimen collection includes specimens from both cervix and endocervix with particular attention to sampling the transformation zone.

  1. Vaginal lubricant should not be used prior to obtaining smear.
  2. After insertion of speculum, swab cervix.

Collect the ThinPrep Pap Test specimen as follows:

  1. Using a broom-like device, insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix.   Apply gentle pressure and rotate the brush 5 times in a clockwise direction.
  2. Rinse the broom as quickly as possible into the PreservCyte Solution vial pushing the broom into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the broom vigorously to further release the material. Discard the collection device
  3. Using the Endocervical Brush/Spatula Device, collect an adequate sampling from the ectocervice using a plastic spatula.
  4. Rinse the spatula as quickly as possible into the PreservCyte Solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.
  5.  Collect an adequate sampling from the ectocervix using an endocervical brush device. Insert brush into the cervix until only the bottom-most fibers are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. DO NOT OVER ROTATE.
  6. Rinse the brush as quickly as possible in the PreservCyte Solution vial by rotating the device in the solution 10 times while pushing against the PreservCytle Solution vial wall. Swirl vigorously to further release material.  Discard the brush.
  7. Place the cap on the vial and tighten so that the torque line on the cap passes the torque line on the vial. Label the vial and place in plastic bags with request slip inserted in separate pocket.

  8. Place specimen in a plastic specimen bag with Cytology Request Form inserted into pocket separate from specimen; and, if possible, deliver specimen to Cytology Laboratory.  

 

Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG), Herpes Simplex Virus 1 & 2, Qualitative, or Reflex Human Papillomavirus (HPV), High Risk Types can be run on the same Thin Prep vial used for Pap smear. If more than 1 test other than Pap smear is ordered, 2 Thin Prep vials need to be collected and sent.

 

Cervix and Endocervix Specimens (Slide Preparation-Conventional)

  1. The specimen collection includes specimens from both cervix and endocervix with particular attention to sampling the transformation zone:
  2. Using a lead pencil, label frosted end of glass slide with patient’s first and last name and second identifier and specimen type prior to obtaining smear.
  3. Vaginal lubricant should not be used prior to obtaining smear.
  4. After insertion of speculum, swab cervix lightly.
  5. With Ayre spatula or cytobrush, make a sweeping motion around squamo-columnar junction.
  6. Spread material evenly on slide making a horseshoe-shaped motion. Apply only light pressure.
  7. Spray slides immediately with cytology fixative before slides dry. Hold spray about 12 inches away from slide.
  8. Place slides in a slide/cardboard holder.
  9. Place specimen in a plastic specimen bag with Cytology Request Form inserted into pocket separate from specimen; and, if possible, deliver specimen to Cytology Laboratory.

Maturation Smear Specimen

For a maturation smear, submit a vaginal smear (cervical smear is not acceptable) as follows:

  1. Using a lead pencil, label frosted end of glass slide with patient’s first and last name and second identifer and specimen type prior to obtaining smear.
  2. Vaginal lubricant should not be used prior to obtaining smear.
  3. Collect vaginal smear from upper third of lateral wall of vagina.
  4. Spread material evenly on slide making a horseshoe-shaped motion. Apply only light pressure.
  5. Spray slides immediately before slides dry with cytology fixative. Hold spray about 12 inches away from slide.
  6. Place slides in a slide/cardboard holder.
  7. Place specimen in a plastic specimen bag with Cytology Request Form inserted into pocket separate from specimen; and, if possible, deliver specimen to Cytology Laboratory.

Specimen Rejection

The following specimens will be returned to submitting physician:

  • No requisition form
  • Name on requisition does not match name on specimen
  • Broken slides that cannot be reconstructed
  • Unlabeled specimen
  • No doctor’s name given
  • Fixation in formalin
  • Air-drying artifact
  • Slides adhered to cardboard folder

Storage and Stability

14 days

Methodology

A genital smear is a screening diagnostic aid. An adequate number of well preserved cells in a specimen is necessary for accurate evaluation and diagnosis of presence or absence of tumors cells. It is useful for detection in asymptomatic patients, in high-risk groups, and in patients with clinically suspected carcinomas. It is also a diagnostic tool in detection of benign processes such as opportunistic infections.

Reference Values

Results will be reported using a modified Bethesda System as follows:

  • Adequacy of specimen
  • Descriptive diagnosis
  • General category
  • Additional findings
  • Hormonal evaluation
  • Comment
  • Recommendation
  • Screened by/reviewed by/pathologist

 

Critical Values: All high-grade squamous and/or glandular intraepithelial lesions or worse.

Days Test Set Up and Turnaround

Monday through Friday, 8:00-5:00pm

Specimens received after hours, weekends, or holidays will be processed the next business day.

Results available within 3 days.

CPT Coding

88141

88143

88155

88165

P3000

P3001

G0124

G0143