Cytopathology

Cytopathology

Cytopathology is a diagnostic technique that examines cells from various body sites to determine the cause or the nature of disease. The first cytopathology test developed was the Pap test, which has been widely utilized in the last 50 years for screening and diagnosing of cervical cancer and its precursors. The Pap test is considered the most successful screening test in medical history.

GYnecologic cytology

INTERPRETATION AND REPORTING:

Interpretation of Pap tests at Physicians Laboratory is performed by cytotechnologists and pathologists. In compliance with the CLIA regulations, supervisory level cytotechnologists perform random rescreen of at least 10% of all Pap tests daily before the reports are released.  


Cases routed to the pathologist for review and signout include:

  • Reactive/reparative specimens
  • All tests containing cellular abnormalities
  • Tests where the cellular pattern and clinical history do not correlate
  • Any test where the screening cytotechnologist may question a totally benign state.
One integrated Pap test result is issued encompassing all testing requested on the ThinPrep vial.  This may include, in addition to the cytology result, high-risk HPV testing, Chlamydia/Gonorrhea testing, and Trichomonas vaginalis testing results.

High-risk HPV testing and reflex testing to types 16, 18/45 may be ordered at the time of Pap collection or ordered within three weeks after receiving the Pap result.  If ordering after the result is received fill out an order form found under the Documents section on this website and fax to the number noted.  
If Chlamydia trachomatis, Neisseria gonorrhea, and Trichomonas vaginalis testing are desired they must be ordered at the time of Pap collection.
SAMPLE COLLECTION:
It is very important that providers fill out all the information requesition on the Gyn cytology requisition.  This ensures the highest quality interpretation and reporting by cytotechnologists and pathologists.  Examples of important information include, but are not limited to, past history of abnormal Pap, abnormal bleeding, patient's LMP, and any hormonal therapies.  Please do not hesitate to call our Client Services department at 605-322-7212 if there are questions about filling out a requisition.

Proper sample collection is very important and for this reason we include printable reference guides for collection. Click on the links to print any of the below guides.

Anal Cytology Specimen Collection
Endocervical Brush-Spatula Collection
Papette Collection
Broom-like Device Collection

The following guidelines should be applied while taking a pap:
  • Patients should be tested during the last half of their menstrual period.  If taking a Pap during a patient’s menstrual period cannot be avoided please swab the cervix with a gauze prior to collection.
  • Avoid using lubricant as this will clog the filter (see information regarding approved lubricants below)
  • Following collection immediately and vigorously rinse the collection device in the vial.  Do NOT leave the collection device in the vial.
USE OF LUBRICANTS DURING PAP TESTING

The use of lubricant during Pap test collection can increase the risk of obscuring the cell sample and also interfere with cell adherence on the slide. It is for those reasons that Physicians Laboratory strongly recommends that only lukewarm water be used to lubricate and warm the speculum. If lubricant must be used for patient comfort, below is a list of those that have been tested and approved by Hologic. Use of non-approved lubricant may result in an increase in unsatisfactory specimens.

Any lubricant should be applied sparingly on the outer portion of the speculum, taking care to avoid the tip. The following lubricants have been tested and approved by Hologic:
  • Surgilube
  • Surgel
  • Pap Test Lubricating Jelly (PP024)
  • KY Jelly
The Aptima HPV Assay has some know interferences also. These include some personal lubricants (containing Polyquatemium 15) and anti-fungal cream containing tioconazole. However, interferences by personal lubricants and anti-fungal cream should not ordinarily be encountered with proper clearing of the cervix before obtaining cell samples for cytology.
RECOMMENDED SCREENING GUIDELINES
Click the link below for summaries of all screening guideline recommendations from the 2012 ACS, ASCCP and ASCP joint task force, the 2018 US Preventive Services Task Force, and the 2016 American College of Obstetricians and Gynecologists (ACOG).
Pap Screening Guidelines
You can also click on the link below for the complete 2014 ASCCP Management Guidelines.
ASCCP Management Guidelines
A summary of screening and management guidelines is provided below.
Patients < 21 years: No screening recommended.
Patients aged 21-29: Cytology alone is recommended every 3 years.  HPV testing should NOT be used for screening in this age group, but is recommended as a reflex for ASC-US (not LSIL).  For HPV-positive ASC-US or LSIL cytology or more severe: refer to ASCCP guidelines.  For cytology negative or HPV-negative ASC-US rescreen in 3 years.
Patients aged 30-65:  There are two recommended strategies:
                                            1.  HPV and cytology "co-testing" every 5 years (preferred)
                                            2. Cytology alone every 3 years
Follow-up:  HPV positive, Cytology Negative:
There are two kinds of follow-up options:
  1. Repeat co-testing in 12 months:
  •  If the follow-up co-test is positive, women should be referred to colposcopy
  •  If the follow-up co-test is negative, women should be screened again with                           co- testing  in 3  years. 
      2.      Immediate HPV genotype-specific testing for HPV or  HPV 16/18/45.  
  •  Women testing positive for either HPV 16 or HPV 18/45 should be referred directlyto           colposcopy.
  •  Women testing HPV 16 or HPV 18/45 negative should be co-tested in 12 months.
                If the follow-up co-test is positive, women should be referred to colposcopy
                If the follow-up co-test is negative, women should be screened again with co-
                            testing in 1 year
Follow-up:  HPV negative, ASC-US cytology: Repeat co-testing in three years
Women > 65 years of age:  Women over 65 years of age with adequate screening history and no history of CIN2 or more severe diagnosis or cervical cancer within the last 20 years should NOT be screened for cervical cancer with any modality.
Women > 65 years of age with a history of CIN2 or more severe diagnosis:
Following spontaneous regression or appropriate management of CIN2 or a more severe  diagnosis, routine screening should continue for at least 20 years even if this extends screening past age 65 years.
Women post-hysterectomy:
Women who have had a hysterectomy (removal of the cervix) should stop screening and not restart fro any reason.  If a cervix is still present screening should continue according to guidelines.


Non Gyn Cytology

Physicians Laboratory receives many different types of non-gynecological specimens. It is important that any specimen sent for cytologic evaluation be collected properly at the clinic or hospital laboratory. Specimen collection requirements and instructions are located under the Client Services tab. If your physician is unsure of how to collect or fix a specimen please refer to them or call our Client Services number at 1-605-322-7212. Many collection procedures are invasive to the patient and we want to be sure that specimens are optimally processed for the best results.


 Molecular Testing For Specific Types of Non-Gyn Specimens

Physicians Laboratory offers several molecular tests for specific types of non-gyn specimens.

  • Anal Cytologies for HR HPV testing (note that if genotyping is requested testing will be performed by another reference laboratory as genotyping is not FDA-approved for anal cytologies at this time)
  • ThyGeNEXT Thyroid Oncogene panel and Thyroid miRNA Diagnostics for further classification of thyroid nodules of undetermined significance
  • UroVysion enhanced bladder cancer detection using FISH
Contact Physicians Laboratory Client Services at 605-322-7212 for more information regarding these and other tests