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Pap Test, ThinPrep®

ThinPrep, Thin layer Pap specimen, ThinPrep Pap test, Liquid based Cytology, PAP TEST (THIN PREP), PAPT

Test Codes

EPIC: LAB6674

Department

Cytology

Instructions

• The pap test is a screening test with limited sensitivity for the detection of cervical cancers and cancer precursors and is subject to both false negative and false positive results.  This report should be interpreted in conjunction with patient history, clinical evaluation, and HPV test results.
• For optimal interpretation a Pap Test should be collected near the middle of the menstrual cycle. A patient should be counseled to refrain from intercourse, douching, using tampons, or using intravaginal medication for at least 48 hours before the examination to decrease the possibility that the number of exfoliated cells will be diminished or obscured by personal lubricants or spermicides. In addition, the patient should avoid scheduling her appointment during heavy menstrual bleeding.
• ThinPrep^® specimen cellularity can be greatly reduced by excessive usage of lubricant or usage of lubricants containing carbomers during the collection of the pap. Surgilube, Pap Test Lubricating Jelly, and CerviLube Lubricant are preferred lubricants that do not contain carbomers. All lubricants should be used sparingly and applied only to the exterior sides of the speculum blades, avoiding contact with the tip of the speculum.

• For HPV testing from the same ThinPrep^® Pap Test vial, please select one of the following choices:

1. HPV Cotesting on patients ≥ 30 years of age
2. HPV Reflex (See reflex algorithm below)
   - Patient is ≥ 21 years old and cytology result is ASCUS
   - Patient is ≥ 30 and cytology result is NILM/NSIL or Reactive/Reparative
   - Patient is ≥ 25 and not pregnant, and cytology result is LSIL
3. No HPV testing

• Chlamydia trachomatis and Neisseria gonorrhoeae testing can also be performed on the same ThinPrep^® Pap Test vial. Testing must be ordered at the same time as the ThinPrep^® Pap Test. It cannot be added after the ThinPrep^® Pap Test has been performed.
• The Cytology Laboratory can provide ThinPrep^® vials and collection devices for specimen collection:
  • Dearborn: 313-436-2369
  • Farmington Hills: 947-521-8247
  • Grosse Pointe: 313-473-1801
  • Royal Oak: 248-898-9035
  • Taylor: 313-295-5365
  • Trenton: 734-671-3868
  • Troy: 248-964-9050
  • Wayne: 734-467-4275
  • Outreach: 800-511-0488

Specimen Collection Criteria

Collect: Cellular material from scraping/brushing in a vial containing 40 cc of ThinPrep PreservCyt^® Solution. Ensure the solution is not expired prior to specimen collection.

• Label the specimen container with an EPIC specimen label with the patient's full name, date of birth, medical record number, source of specimen, test(s) ordered, and date of test.
• Specimen may be procured with a cervi-spatula and brush OR a broom like device.
• For Endocervical Spatula and Brush:
  • Obtain an adequate sampling from the ectocervix using a plastic spatula. Rinse the spatula into the PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times. Discard the spatula.
  • Obtain an adequate sampling from the endocervix using an 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. Rinse the brush by rotating the device in the PreservCyt^® solution 10 times while pushing against the wall of the vial. Swirl the brush vigorously to further release material. Discard the brush.
• For Broom-Like Device:
  • Obtain an adequate sampling from the cervix using a broom-like 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 5 times.
  • Rinse the broom into the PreservCyt^® solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the broom vigorously to further release material. Discard the collection device.
• Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten the cap on the vial.
• In house cytology specimens should be ordered in EPIC order entry. In the “additional orders” field input “CYTOLOGY PAP TEST (ThinPrep^®)” and fill in all appropriate fields. Label specimen container and requisition with EPIC specimen labels. All Cytology specimens must be accompanied by a requisition and must include the patient name, medical record and visit/CSN number, date of birth, date of specimen collection, pertinent patient history, ordering physician name and source of specimen. Place an EPIC specimen label on the requisition.
• OR specimens ordered using specimen navigator:  Testing will be delayed unless specimen source is provided.  Please order test in specimen navigator and fill out paper requisition provided with ThinPrep^® vial (patient name, medical record and visit/CSN number, date of birth, date of specimen collection, pertinent patient history, ordering physician name, source of specimen, screening vs. diagnostic pap, ICD-10 code, HPV test request, LMP/menstrual status). LMP/menstrual status). Label the specimen container and requisition with an EPIC specimen label with the patient's full name, date of birth, medical record number, and test(s) ordered.
• NOTE:  If pap specimen was collected during evaluation of patient candidacy for transplant, please indicate STAT on the requisition and specimen vial.
  

Physician Office/Draw Specimen Preparation

Maintain vial containing sample and ThinPrep^® PreservCyt^® Solution at room temperature (20-26°C or 68-78.8°F) prior to transport to the Laboratory.

Preparation for Courier Transport

Rejection Criteria

• Improper labeling of specimen container or requisition.
• Specimen not accompanied by requisition.
• Requisitions not accompanied by a specimen.
• Improper collection of specimen (such as improper fixation).
• Any specimen received without all of the required information will result in a delay of processing until all information can be verified. (Date of service, date of birth, last menstrual period, etc.)
• Specimens that leak outside of specimen container into transport bags. Even if a small amount of fluid leaks out it can dissolve the ink on the patient identifiers written/labeled on the vial, making it an unacceptable specimen.

Inpatient Specimen Preparation

Farmington Hills

• Deliver the specimen directly to the Anatomic Pathology Department.
• After 4:00 pm and on weekends/holidays, deliver to Laboratory Central Processing.

Grosse Pointe

• Deliver the specimen directly to the AP Lab (first level) Monday-Friday, 8:30 am – 4:00 pm.  After hours the specimens are taken to the main lab (first floor) and placed in the fridge.
• Specimens are also picked up throughout the day from the surgical floors and Clinical Pathology Monday – Friday, 8:30 am – 4:00 pm. GP surgical specimens are picked up from the main OR every 2 ½ hours. Endoscopy specimens are delivered to the AP lab throughout the day.
  
• When the AP laboratory is closed, specimens may be delivered to the Clinical Pathology Specimen Processing area. Specimens are to be placed in the fridge closest to the door after hours.
  

Royal Oak

• Deliver specimen directly to the Cytology Laboratory (Research Building, lower level) Monday – Friday, 6:00 am – 4:30 pm or to Clinical Pathology Specimen Receiving (located on the first floor of the Beaumont Laboratory Research Building).
• Specimens are also picked up from the surgical floors, Endoscopy and Clinical Pathology Monday – Friday, 8:00 am – 7:00 pm, Saturday, 7:00 am – 11:00 am, NT and Endoscopy ONLY.

Troy

• All specimens must be hand-delivered to the Specimen Reception department; phone number: 248-964-8615.
  

Dearborn

• Deliver the specimen to the main lab drop off window and sign in. Open 24/7.
• Deliver directly to Cytology, Monday – Friday, 7:00 am – 5:00 pm. 
• Deliver directly to Histology lab, Monday – Friday open 24 hours, Saturday 8:00 am – 12:00 pm, closed on Sunday.
• Specimens are also picked up throughout the day from the surgical area and endoscopy. Monday – Friday, 6:00 am – 4:30 pm, Saturday 8:00 am – 12:00 pm.
• When the Cytology lab is closed specimens must be delivered to the main lab window and signed in.

Taylor

• Deliver to histology 8:00 am – 2:00 pm. 
• After hours:  Deliver the specimen to the main lab. Open 24/7.

Trenton

• Specimens are picked up from Emergency Dept., Interventional Radiology, and operating rooms from 8:00 am – 2:00 pm.
• After hours deliver specimens to the main lab. Open 24/7.

Wayne

• Specimens are picked up from Emergency Dept. and Interventional Radiology from 8:00 am – 2:00 pm.
• After hours deliver specimen to the main lab. Open 24/7. 

Storage

Specimen Stability for Testing:

Room Temperature (20-26°C or 68-78.8°F): 6 weeks
Refrigerated (2-8°C or 36-46°F): Acceptable, but not recommended
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

Room Temperature (20-26°C or 68-78.8°F): 30 days

Laboratory

Royal Oak Cytology Laboratory
Farmington Hills, Grosse Pointe and Troy paps are sent to Royal Oak Cytology Laboratory for preparation and screening. Pap final results are issued at Royal Oak, Farmington Hills, Grosse Pointe and Troy.

Dearborn Cytology Laboratory
Taylor, Trenton and Wayne specimens are sent to Dearborn Cytology Laboratory for preparation, screening and issuing final results.  

Performed

Monday – Friday, 6:00 am – 4:30 pm. (Royal Oak).
Monday – Friday, 7:00 am – 4:30 pm (Dearborn).
 
Most results are available within 48 hours of receipt in the Cytology Laboratory if received Monday – Friday. The Cytology Laboratory is closed on weekends and holidays. Specimens received after 3:00 pm on Friday will be processed the following Monday and resulted on Tuesday. Specimens received after 3:00 pm the day before a holiday will be processed the next working day and resulted out within 48 hours. 

Test Methodology

Thin layer cytologic preparation, ThinPrep^® imaging system (Most ThinPrep^® specimens are successfully imaged by the imaging system. However, up to 7% may be unsuccessfully imaged and require manual screening by a Cytotechnologist).

CPT Codes

CPT: 88142 (88175 if imaged Pap, 88141 in the event of a professional review).
LOINC: 47527-7. 

Contacts

Last Updated

10/22/2024