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Pap Smear (Liquid Base Prep), Cytology

Important Note

HPV add-on to previously submitted gynecologic Pap test:

- For e-DH users, please submit a Pathology Order Update (LAB3748) with the Epic Order ID from the original GYN Pap order. Include ‘HPV add-on’ in the comment section.   For ordering assistance, please contact the e-DH help desk at: (603) 650-9060

- For Non e-DH users, please send a HPV add-on request to our Client Response Center (CRC) at: fax (603) 650-8151.  For questions, contact CRC via phone: (603) 650-2200.

eD-H Order Code

LAB3186

Specimen Collection Information

Specimen Container
Cervical/Endocervical/Vaginal Brushing or Scraping

Specimen Transport Temperature

Deliver to Lab Specimen Receiving (LSR), Borwell level 4.

Specimen Stability

Ambient

Additional Testing Information

Patient Prep:
Smears should not be obtained:
• within 24 hours of douching
• within 4 weeks of cauterization or freezing
• within 2 weeks of D & C, or
• during excessive bleeding *
*Menstrual blood can obscure significant findings; therefore, it is preferable to avoid sample collection during menses. It is ideal to schedule an exam two weeks after the first day of the last menstrual period (i.e. mid-cycle). ACOG and CLSI guidelines state that one should avoid sample collection during menses. According to the CLSI guidelines, a woman should be advised to schedule the examination “two weeks after her last menstrual period and preferably when she is not menstruating.”
Reference: Papanicolaou Technique Approved Guidelines (NCCLS Document GP15-A).

Specimen Collection:
1. Label ThinPrep PreservCyt container with patient’s full name, and date of birth or MRN (if available). Indicate specimen source.
2. Insert the vaginal speculum without lubricant. (Rinse with warm water is acceptable). Remove copious secretion with a large swab. The cervical mucus plug should also be gently removed with a moistened swab.

Brush/Spatula Protocol OR Broom-Like Device Protocol may be used.
Brush/Spatula Protocol:
1. Label ThinPrep PreservCyt container with patient’s full name, and date of birth or MRN (if available). Indicate specimen source.
2. Use the spatula as the first collection device. Select contoured end of plastic spatula and rotate it 360 degrees around the entire exocervix while maintaining tight contact with exocervical surface.
3. Rinse the spatula as quickly as possible into the PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.
4. Next use the endocervical brush device. Insert the brush into the cervix until only the bottommost fibers are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. DO NOT OVER-ROTATE.
5. Rinse the brush as quickly as possible in the PreservCyt solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall. Swirl the brush vigorously to further release material. Discard the brush.
6. Tighten the cap so that the torque line on the cap passes the torque line on the vial.
7. Complete the Cytopathology Gynecological requisition/order by filling in all appropriate sections, indicating specimen site, and including pertinent clinical history (i.e. ICD-10, last menstrual period, hysterectomy, postpartum, pregnant, IUD, pelvic radiation, prior GYN therapy, history of abnormal Pap or cervical biopsy, etc.)
Broom-Like Device Protocol:
1. Label ThinPrep PreservCyt container with patient’s full name, and date of birth or MRN (if available). Indicate specimen source.
2. Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. Push gently and rotate the broom in a clockwise direction five times.
3. Rinse the broom as quickly as possible into the PreservCyt solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart. Swirl the broom vigorously to further release material. Discard the collection device.
4. Tighten the cap so that the torque line on the cap passes the torque line on the vial.
5. Complete the Cytopathology Gynecological requisition/order by filling in all appropriate sections, indicating specimen site, and including pertinent clinical history (i.e., ICD-10, last menstrual period, hysterectomy, postpartum, pregnant, IUD, pelvic radiation, prior GYN therapy, history of abnormal Pap or cervical biopsy, etc.)

Label: Patient full name and date of birth or MRN (if available), as well as specimen type.

Requisition/Order: Cytopathology Gynecological Request (Form F312A); e-DH number LAB3186

Required clinical Information including: last menstrual period. Check the appropriate response box for the following: Currently on GYN hormones compound, Hysterectomy, Postpartum, Pregnant, IUD, Pelvic Radiation, Prior GYN Therapy (Cone Biopsy, Cautery, Cryotherapy, Surgery, Etc.) History of previous atypical Pap or cervical biopsy.
Incomplete requisitions may require an updated requisition.

HPV Testing Options:
1. Pap testing only. No High Risk HPV testing will be completed. Provider has the opportunity to add on HPV testing if they notify Lab at 603-650-2200 and submit a new order for HPV only.
Note: Sample will be discarded 30 days from collection date.
2. Reflex HPV testing. High Risk HPV testing will be done if the result of Pap testing is ASCUS (atypical squamous cells-undetermined significance).
3. High Risk HPV testing only.
4. Concurrent Pap and High Risk HPV testing. Regardless of the Pap test result, High Risk HPV testing will be performed.

D.E.S., Cytology
Note: This sample must be taken before any routine cervical or endocervical samples, and submitted in a separate ThinPrep PreservCyt vial with a separate requisition/order. Label vaginal smear for D.E.S.

Specimen Collection:
1. Label ThinPrep PreservCyt container with patient’s full name, and date of birth or MRN (if available). Indicate specimen source.
2. Perform 4-quadrant vaginal collection, with rotation of the speculum so that all vaginal walls can be inspected and sampled.
3. Rinse the spatula as quickly as possible into the PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.
4. Tighten the cap so that the torque line on the cap passes the torque line on the vial.
5. Complete the Cytopathology Gynecological requisition/order by filling in all appropriate sections, indicating specimen site, and including pertinent clinical history (i.e., ICD-10, last menstrual period, hysterectomy, postpartum, pregnant, IUD, pelvic radiation, prior GYN therapy, history of abnormal Pap or cervical biopsy, etc.)

Day(s) Performed

Monday through Friday; 7:30 a.m. – 5 p.m.

Turnaround Time

5-10 working days upon laboratory receipt of specimen.

Performing Lab Section

Cytology