Cytopathology: Clinical Services - Submit a gynecologic sample

General

The detection of cervical cancer, and their precursor lesions, as well as other gynecologic abnormalities, is the primary purpose of cervical cancer screening. CLSI guidelines state that it is important to obtain a gynecologic specimen that is free of obscuring blood, mucus, inflammatory exudates, and lubricant. Examination glove powder can also be an interfering substance and obscure the specimen making the slide uninterpretable. The use of lubricants with the ThinPrep Pap test is not recommended. Lukewarm to warm and lubricate the speculum is the preferred speculum preparation method. However, if procedural lubricant is necessary, the following lubricant brands have been validated by Hologic for use with the ThinPrep Pap test when used as instructed: 

A complete list of unapproved procedural lubricants can be provided upon request. Contact the Cytology Supervisor Seth Trujillo at sptrujilo@ucdavis.edu.

The following images are examples of unsatisfactory and satisfactory gynecologic ThinPrep Pap test specimens:

Label all collection related consumables with two forms of patient identification. If slide(s) are prepared at the collection site, label the frosted end of the slide with two from of patient identification using a lead pencil.

Note: Specimens submitted without two forms of patient identification will be considered unlabeled and may be rejected.

Note: Do not pool multiple collection sites together into a single Gyn ThinPrep vial.

Note: Do not use expired consumables.

Note: Gynecologic Pap specimens are viable for testing up to 6 weeks post collection.

Note: Do not use a wooden collection device.

Note: Do not cover the volume line window with a specimen label. 

Note: If a separate swab specimen is to be collected for molecular testing, the Pap specimen must be collected first.

Note: ThinPrep PreservCyt media (with or without specimen) should be kept between 15⁰ C (59⁰ F) and 30⁰ C (86⁰ F). Do not freeze.

Patient information

To avoid the presence of obscuring blood, or other interfering substances, the following should be considered:

·         The patient should be sampled two weeks after the first day of her last menstrual period and not when she is menstruating.

·         The patient should avoid using vaginal medication, vaginal contraceptives, vaginal creams, vaginal jellies, or douche during the 48 hours prior to the exam/Pap collection.

·         The patient should refrain from intercourse 48 hours prior to the exam.

Specimen collection

·         Prepare the speculum:

-          For patients without the physical or physiological need for procedural lubricant, the use of lukewarm water to warm and lubricate the speculum is the preferred method to prepare the speculum.

-          Water lubrication has the fewest risks to the quality of the Pap sample collected and avoids introducing any interfering substance if molecular testing is performed on the ThinPrep specimen.

-          When necessary, sparingly apply carbomer-free procedural lubricant to the exterior of the speculum blades. Avoid applying any procedural lubricant to the tip of the speculum. Do not use an excessive amount of lubricant jelly to lubricate the speculum.  

·         Remove excess mucus or other discharge present prior to taking the sample. Excess mucus should be removed with ring forceps holding a folded gauze pad.

-          Excess cervical mucus is known to be devoid of diagnostically relevant material and may prevent adequate sampling to occur.

·         Remove inflammatory exudate from the cervical canal prior to taking the sample. Remove excessive inflammation by placing a dry 2x2 inch piece of gauze over the cervix and peeling the gauze away after it absorbs the exudate or by using a dry procto swab or Scopette swab.

·         The cervix should not be cleaned by washing with sterile saline.

·         The Pap specimen should be obtained prior to the application of acetic acid.

·         Refer to Hologic’s ThinPrep Pap Test Quick Reference Guides, Part No.s DS-05867-001 and DS-05720-001, and ThinPrep® Pap Test Specimen Collection Protocol Video 3.

1. Conventional Cytology Smear (glass slide):

Obtain the specimen with a brush (preferred), broom or spatula, lightly scraping the entire endocervix (360° degree sweep). Collection with a cotton tipped swab is strongly discouraged. Cellular material tends to adhere to cotton fibers and increased drying artifact may be introduced; thus producing a less than optimal sample. Once the specimen has been procured with the appropriate collection device, spread the exfoliated material evenly and smoothly over the surface of the glass microscope slide. Immediately spray fix the slide with an alcohol-based Cytology spray fixative. Transport the slide(s) in a cardboard or plastic slide container, labeled with two forms of patient identification.

2. ThinPrep Pap Test (liquid-based preparation):

A) Ectocervix

SPATULA DEVICE

-          Obtain an adequate specimen utilizing a plastic spatula. Select the contoured end of the plastic spatula and rotate it 60 degrees around the entire ectocervix while maintaining tight contact with the ectocervical surface.

-          Rinse the spatula as quickly as possible in the GYN ThinPrep PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula collection device.

-          Tighten the cap of the GYN ThinPrep PreservCyt vial so that the torque line on the cap passes the torque line on the vial.

-          Record the patient’s name and ID number on the Pap vial.

-          Record the patient’s information and medical history on the requisition form.

-          Place the vial and requisition in a specimen bag and transport to the laboratory.  

B) Endocervix

BROOM-LIKE DEVICE

-          Obtain an adequate sampling of the endocervix using the provided endocervical broom device. 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 for 5 complete 360 degree turns.

-          Rinse the broom collection device as quickly as possible into the GYN PreservCyt Solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart while pressing the bottom of the vial. Swirl the broom vigorously to further release cellular material.

-          Remove and discard the collection device from the Gyn ThinPrep PreservCyt vial. No collection device should be left in the vial. No not pop off the head of the broom and leave it in the vial. Do not clip off the head of the broom and leave it in the vial.

-          Tighten the cap of the GYN ThinPrep PreservCyt vial so that the torque line on the cap passes the torque line on the vial.

-          Record the patient’s name and ID number on the Pap vial.

-          Record the patient’s information and medical history on the requisition form.

-          Place the vial and requisition in a specimen bag and transport to the laboratory.   

ENDOCERVICAL BRUSH

-          Obtain an adequate sampling of the endocervix using the endocervical brush device. Insert the brush into the cervix until only the bottom-most fibers are exposed. Slowly rotate ¼ or ½ in one direction. DO NOT OVER-ROTATE THE BRUSH.

-          Rinse the brush collection device as quickly as possible into the GYN PreservCyt Solution vial by rotating the device in the solution 10 times while pushing it against the PreservCyt vial wall. Swirl the brush vigorously to further release cellular material.

-          Remove and discard the collection device from the Gyn ThinPrep PreservCyt vial. No collection device should be left in the vial.

-          Tighten the cap of the GYN ThinPrep PreservCyt vial so that the torque line on the cap passes the torque line on the vial.

-          Record the patient’s name and ID number on the Pap vial.

-          Record the patient’s information and medical history on the requisition form.

-          Place the vial and requisition in a specimen bag and transport to the laboratory.  

Clinical History

Provide the patients’ name, date of birth, date of last menstruation and brief clinical history on the laboratory. The date of collection must be noted on the requisition. Specimens received without adequate history may be rejected as unsatisfactory or considered less than optimal for evaluation. Please include a valid Physician Index Number and ICD-9 Diagnosis code.

Give name, date of birth, date of last menstruation and brief clinical history on the laboratory. The date of collection must be noted on the requisition. Specimens received without adequate history may be rejected as unsatisfactory or considered less than optimal for evaluation. Please include a valid Physician Index Number and ICD-9 Diagnosis code.