Thin Prep-HPV DNA, High Risk & 16/18 w/PAP reflexÂ

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Test Code
HPVFX


Alias/See Also
Epic: LAB15853


Includes
This is a test for Primary HPV screening  of women  ≥ 25 years old. This test algorithm starts with Real time PCR for detection of High Risk HPV-16 , HPV-18 , and HPV Other  (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) . If HPV with genotyping by PCR is Positive for HPV other and Negative for types 16 and 18, then cytology reflex test will be performed at an additional charge.

Cytology reflex is Test Code TPAPI-ThinPrep Imaging Pap



Preferred Specimen

Original ThinPrep/PreservCyt collection vial is required for testing.

For optimal interpretation, Pap smears should be collected near the middle of the menstrual cycle. Avoid douching, lubricant use, and sexual intercourse for 24 hours prior to specimen collection.

Cervical specimens should be collected by a clinician using an endocervical brush/spatula or a cervical broom and placed in the ThinPrep® Pap Test™ PreservCyt® Solution. NOTE: Products containing carbomer(s), including vaginal lubricants, creams and gels may interfere with the test and should not be used during or prior to collecting cervical specimens. 

Specimen source is required.

Submit only 1 of the following specimens:



Broom Collection Device:

Specimen Type: Cervical (endocervical or ectocervical)

Collection Container: ThinPrep/PreservCyt vial

Specimen Volume: 20 mL of solution in ThinPrep/PreservCyt vial



Endocervical Brush/Spatula Collection Device:

Specimen Type: Ectocervix and endocervix

Collection Container: ThinPrep/PreservCyt vial

Specimen Volume: 20 mL of solution in ThinPrep/PreservCyt vial​




Instructions
Broom Collection Device:
  1. Obtain adequate sampling from cervix using a broom-like collection device. If desired, use lukewarm water to warm and lubricate the speculum. 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.
  2. Rinse the broom as quickly as possible into the PreservCyt solution vial by pushing broom into bottom of vial 10 times, forcing the bristles apart.
  3. As a final step, swirl broom vigorously to further release material. Discard the collection device.
  4. Tighten cap on vial so that the torque line on the cap passes the torque line on the vial.
  5. Specimen vial must be labeled with a minimum of 2 unique identifiers (patient's name and medical record number or date of birth).
  6. Bag ThinPrep specimens individually as they have a tendency to leak during transport.
  7. Place labels on the vial and on the bag.

Endocervical Brush/Spatula Collection Device:
  1. Obtain an adequate sampling from the ectocervix using a plastic spatula. If desired, use lukewarm water to warm and lubricate the speculum. Select contoured end of plastic spatula and rotate it 360 degrees around the entire exocervix while maintaining tight contact with exocervical surface.
  2. Rinse spatula as quickly as possible into the PreservCyt solution vial by swirling spatula vigorously in vial 10 times. Discard the spatula.
  3. Next, obtain an adequate specimen from 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.
  4. Rinse the brush as quickly as possible in the PreservCyt solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall.
  5. Swirl brush vigorously as final step to further release material. Discard the brush.
  6. Tighten the cap so that the torque line on the cap passes the torque line on the vial.
  7. Specimen vial must be labeled with a minimum of 2 unique identifiers (patient's name and medical record number or date of birth).
  8. Bag ThinPrep specimens individually as they have a tendency to leak during transport.
  9. Place labels on the vial.


Specimen Stability

Room temperature: 3 months
Refrigerated: 3 months
Frozen: Unacceptable




Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Specimens with concentrations of whole blood exceed 1.5% (dark red or brown coloration).




Methodology

This test utilizes Roche real time PCR for the detection of high risk Human Papillomavirus (HPV) DNA.  The test specifically identifies genotypes HPV16 and HPV18 while concurrently detecting a pool of 12 other high-risk HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). 



Report Available

≤4 Days for HPV DNA (additional time for reflex cytology (if indicated))




Limitations

Results of this test should only be interpreted in conjunction with information available from clinical evaluation of the patient and patient history. A negative test result indicates HPV DNA concentrations are undetectable or below the pre-set threshold. HPV negative results are not intended to prevent women from proceeding to colposcopy. The performance of this HPV test with ThinPrep Pap Test PreservCyt® Solution has not been adequately established for HPV vaccinated individuals. This test is not recommended for evaluation of suspected sexual abuse.
This test is not intended for women who have undergone hysterectomy.  Use of over-the-counter products Replens™, RepHresh™ Vaginal Gel and RepHresh™ Clean Balance™ Kit has been associated with false-negative results. Use of Metronidazole Vaginal Gel has been associated with false-negative results.




Reference Range
Negative for HPV16, 18 , 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68.


Clinical Significance
In women 25 years and older, this HPV test can be used for specimens collected only in ThinPrep Pap Test PreservCyt® Solution as a first‐line primary cervical cancer screening test to detect high risk HPV, including genotyping for 16 and 18. Women who test negative for high risk HPV types by this HPV Test should be followed up in accordance with the physician's assessment of screening and medical history, other risk factors, and professional guidelines. Women who test positive for HPV genotypes 16 and/or 18 by this HPV Test should be referred to colposcopy. Women who test high risk HPV positive and 16/18 negative by this HPV Test (12 other high risk HPV positive) should be evaluated by cervical cytology to determine the need for referral to colposcopy.

This test is a Primary HPV screen recommended in The American Cancer Society’s guidelines. Fontham, ETH, Wolf, AMD, Church, TR, Etzioni, R, Flowers, CR, Herzig, A, Guerra, CE, Oeffinger, KC, Shih, Y-CT, Walter, LC, Kim, JJ, Andrews, KS, DeSantis, CE, Fedewa, SA, Manassaram-Baptiste, D, Saslow, D, Wender, RC, Smith, RA. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020: 70: 321- 346. https://doi.org/10.3322/caac.21628



Performing Laboratory

Inova Laboratories

2832 Juniper Street

Fairfax, VA 22031



Additional Information
ThinPrep Pap Collection Guide

Last Updated: May 10, 2023
Last Review: N. Wolford, May 10, 2023


The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.