GYNECOLOGIC SPECIMENS

Thin PrepÒ Pap TestÔ

Indication:

Sampling of the superficial cells of the cervix, endocervix and/or vagina to detect premalignant and malignant lesions of the uterine cervix and other abnormalities of the reproductive tract. The Thin PrepÒ Pap TestÔ is intended as a replacement for the conventional method of Pap smear preparation. Studies have shown that this procedure decreases fixation artifacts, provides a more uniform specimen for microscopic evaluation and increases the yield of abnormal cells.

Supplies:

Vaginal speculum, * Thin PrepÒ Collection Kit (which includes plastic spatula and brush or broom device, and PreservCytÒ Solution vial), *LMC gynecologic cytology requisition form, *biohazard bag for specimen transport. (*items provided by LMC)

Please note the following Thin PrepÒ Pap TestÔ important information:

· Wooden spatulas cannot be used for the Thin PrepÒ Pap TestÔ. The wood is porous and cellular material will stick to the collection device and not be transferred to the collection vial. The Thin PrepÒ Pap TestÔ is only FDA approved for use with the plastic spatula device, brush or broom device.

· Caution: PreservCytÒ solution contains methanol, which is poisonous and may be fatal or cause blindness if swallowed. Vapor is harmful if inhaled. This solution causes eye and skin irritation. PreservCytÒ is flammable: keep away from fire, heat, sparks and flame. Other solutions must not be substituted for PreservCytÒ solution. PreservCytÒ should be stored and disposed of in accordance with local, state and federal regulations. Check the expiration date on the vial prior to use. The laboratory cannot accept samples in expired PreservCytÒ solution.

Requisition form:

Submit all patient information following the procedure for “Completing a Gynecologic Cytology Requisition” (page 27).

Collection Procedure:

In premenopausal patients, obtain specimen during second half of menstrual cycle (if possible) to avoid obscuring blood. Instruct the patient not to douche or engage in sexual intercource within 24 hours of the procedure

1. Print the patient’s name (last, first) on the PreservCytÒ solution vial. The laboratory CANNOT accept unlabeled specimens. Check the expiration date to be sure the solution has not expired. The laboratory CANNOT accept specimens in expired solution vials.

2. Place the patient in the lithotomy position. Using a speculum lubricated with warm water, expose the cervix as fully as possible. DO NOT use lubricant as this will interfere with the cytologic evaluation.

3. If excess mucus, exudates or blood is present at the cervical os, remove with a folded gauze pad or large cotton-tipped swab.

4. SPATULA/BRUSH TECHNIQUE: Obtain an adequate sample from the ectocervix (and transition zone if visible) by rotating the plastic spatula device five times around the circumference of the cervix. Rinse the spatula in the PreservCytÒ solution vial by swirling the spatula vigorously 10 times in the vial. Discard the spatula. Obtain an adequate sample from the endocervix by inserting the brush device into the cervix until only the bottom most fibers are exposed. Slowly rotate ¼ to ½ turn in one direction. DO NOT OVER ROTATE. Rinse the brush in the PreservCytÒ solution by rotating the device in the solution while pushing against the wall of the vial. Rotate 10 times. As a final step, swirl the brush vigorously to further release material. Discard the brush.

BROOM TECHNIQUE: Obtain an adequate sample from both the ectocervix and endocervix simultaneously by inserting the center of the device into the cervical os until gentle resistance is felt and the outer-most tips of the broom are flat on the ectocervix. Push gently and rotate the broom five times, in a clockwise direction, 360 degrees around the os. Rinse the broom in the PreservCytÒ solution vial by rotating the device in the solution 10 times, pushing the bristles of the broom against the bottom and edges of the vial (like rinsing a paint brush) to dislodge the material. Discard the broom. DO NOT cut off the end of the collection device and leave in the vial. The cellular material will harden onto the device and not effectively transfer to the solution.

5. Tighten the cap on the PreservCytÒ solution vial so the torque line on the cap passes the torque line on the vial.

6. Use the specimen collection biohazard bags provided by LMC. Place the completed requisition in the outside pocket and the properly labeled PreservCytÒ solution vial in the zip lock portion of the bag. Send to Laboratory Medicine Consultants for processing. The laboratory CANNOT accept unlabeled vials or specimens without a properly filled out requisition form.

If additional educational materials are desired on the proper collection technique used for the Thin PrepÒ Pap TestÔ, please contact Laboratory Medicine Consultants.