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Test Code LAB4 Liquid Based Pap Test

Methodology

 Liquid-base cytology with Imaging

Performing Laboratory

Bozeman Health Laboratory Services

Required Forms

Please submit the following forms with the specimen:

 

1. Cytology Test Requisition Form 

This form should include the following:

  1. Patient’s name (first and last)
  2. Date of birth
  3. Social Security number
  4. Patient address, phone number, and insurance information
  5. Date and actual time of collection
  6. Source of material (cervical, endocervical, vaginal)
  7. Physician’s name (first and last)
  8. Physician’s phone number
  9. Number of slides submitted
  10. Indicate if maturation index testing is also desired.
  11. Clinical information, including the following:
  • Date of last menstrual period
  • Hormonal status (eg, postmenopausal, pregnant)
  • Exogenous hormone therapy (including birth control pills, treatment for endocrine responsive malignancy, estrogen creams)
  • Presence of intra-uterine device
  • Diethylstilbestrol (DES) exposure
  • History of cervical intraepithelial neoplasia, cervical malignancy, or any extragenital malignancy
  • History of systemic chemotherapy
  • History of pelvic radiotherapy
  • History of gynecologic surgery, cryosurgery, electrocautery, or laser surgery
  • Date of last gynecological smear and history with dates of any previous abnormal histology or cytology reports
  • Any current abnormal findings or patient complaints
  • High-risk factors for cervical cancer (eg, sexually transmitted diseases, sexual activity at an early age, and number of pregnancies, and smoker if obtainable)

2. Advance Beneficiary Notice

If the patient is on Medicare, complete and submit an ABN.

Special Instructions

Specimen Requirements

Call Bozeman Deaconess Cytology Laboratory at 414-5057 or fax a request to 414-5117 to obtain collection materials.

 

ThinPrep Vial

Specimen Type: Exocervix

Container/Tube: ThinPrep vial

Specimen Volume: Adequate amount

Collection Instructions:

  1. Label ThinPrep vial with patient’s name (first and last).
  2. Do not use lubricant on speculum.
  3. Visualize cervix with a speculum.
  4. To collect specimen from exocervix, select contoured end of plastic spatula and rotate it 360° around entire exocervix while maintaining tight contact with exocervical surface. Remove spatula.
  5. Rinse contoured end of plastic spatula into PreservCyt Solution vial by swirling spatula vigorously in vial 10 times. Discard spatula. Place cap on vial.
  6. Obtain an adequate sampling from endocervix using an endocervical brush device. Insert brush into cervix until only bottom-most fibers are exposed. Slowly rotate one quarter or one half turn in 1 direction. Do not over-rotate. Additional rotation may cause bleeding and contaminate specimen. Note: A cervical “broom” or Papette may be used in lieu of spatula/cervical brush if desired. It is extremely important to immediately dislodge cellular material and not allow collection devices to sit in fixative or cells will become trapped to/in collection device.
  7. Rinse brush in PreservCyt Solution vial by rotating device in solution 10 times while pushing against PreservCyt vial wall. Swirl brush VIGOROUSLY to further release material.
  8. Discard collection device after depositing cellular material in vial. Do not send collection device in vial.
  9. Tighten cap so torque line on cap passes torque line on vial.
  10. Place specimen in plastic specimen bag with request form inserted into pocket separate from specimen, and, if possible, deliver specimen to Cytology Laboratory.
  11. Avoid temperature extremes (<0° F or >120° F) during transport.

Specimen Rejection: The following specimens will be returned to the submitting physician:

  1. No request form submitted with the specimen.
  2. Name on request form does not match name on specimen container
  3. Unlabeled specimen
  4. No doctor’s name given
  5. Broken slides that cannot be repaired
  6. Air-drying artifact
  7. Slides adhered to cardboard holder
  8. Specimens fixed in formalin

Specimen Transport Temperature

Ambient

Reference Values

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

  • Satisfactory for evaluation
  • General category
  • Descriptive diagnosis
  • Screened by/reviewed by pathologist
  • Reporting nomenclature
  • Bethesda 2014 is our standard reporting method

Day(s) Test Set Up

Monday through Friday

Test Classification and CPT Coding

88142-Cytopathology, cervical or vaginal (Bethesda system) collected in preservative fluid, automated thin-layer preparation; manual screening under physicians supervision. (ThinPrep slide unable to be imaged) (if appropriate)

88155-Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (if appropriate)

88175-Cytopathology, cervical or vaginal (the Bethesda system) collected in preservative fluid, automated thin-layer preparation; with automated system and manual rescreening or review, under physicians supervision. (Imaged ThinPrep) (if appropriate)

G0144-Medicare screen LB auto (if appropriate)
G0145-Medicare screen LB auto and manual (if appropriate)

P3000-Pap smear Medicare screening (if appropriate)