Cytology, GYN PAP

Test Code

Cytology, GYN

Alias/See Also

PAP Smear, PAP, Papanicolaou smear

Preferred Specimen

Patient Preparation: Pap may be taken anytime in the cycle except during menses. Ideal time is midcycle. Patient should not douche or use vaginal medications for 48 hours prior to collection of Pap smear.

Conventional Technique:

Label frosted end of slide with patient’s name, medical record number and site of smear (V for Vaginal, C for Cervical, E for Endocervical, EB for Endocervical Brush, EM for Endometrial aspirate). Use a #2 Pencil. Note: A labeled Pap Pak is not sufficient for optimal patient identification. The slide itself must be labeled with name and medical record number.
Lightly scrape the entire ectocervix, especially the borders of erosions, with a spatula and have a nurse hold this spatula.
Insert cytobrush into cervical canal and rotate 180 to 360 degrees and immediately spread this on the slide in a rotating manner with moderate pressure. Then smear the specimen on the spatula onto the slide.
Spray the slide IMMEDIATELY with Cytology fixative to fix the cellular material and prevent air-drying. Allow the smear to dry after fixative has been applied, and before closing the slide holder.
For Hormonal Cytology (Maturation Index), submit a lateral vaginal wall sample.
- Obtain first before any of the above specimens to avoid contamination by cervical or endocervical samples.
- Gently scrape the upper third of the lateral vaginal wall.
- Spread on slide and immediately spray with cytology fixative to fix.
Always allow the smear to dry after fixative has been applied, and before closing the slide holder. Wet smears adhere to cardboard folders. Artifacts, cellular distortion, and loss of cytologic material may occur if cardboard fibers are dried into the smear.
Transport the smear in Pap pack or cardboard slide folder, securely fastened with scotch tape to prevent slide loss. If the smear is to be mailed, a special mailer with a plastic slide protector sleeve must be used inside the mailing envelope because the flat cardboard slide folders do not offer adequate protection from breakage in transit.

Liquid Base Technique:

Label the specimen vial with the patient's name and medical record number.
Collect specimen. Use the Cyto=Broom Device. Insert broom into the cervical os. Turn the broom clockwise five full rotations.
Place specimen in device of choice:
1. ThinPrep: insert the broom into the ThinPrep vial and agitate vigorously. Screw on lid tightly and submit to laboratory.
2. SurePath: Snap off broom head and place in SurePath vial. Screw on lid tightly and submit to laboratory.

Instructions

Submit Pap smear with the Cytology Requisition form filled out in its entirety along with a face sheet from patient registration. The clinical history information requested is necessary for proper evaluation of the specimen, and must minimally include: patient’s name, source of specimen, social security number, requesting physician’s name, patient date of birth, date of specimen collection, and pertinent clinical history (date of the last menstrual period, menopausal status, current pregnancy, oral contraceptive or IUD use, estrogen replacement therapy, and previous therapeutic procedures). Patients at increased risk for cervical carcinoma should be identified as such on the requisition form. Check the "DIAGNOSTIC" box on the requisition form for all patients at high risk, check the "SCREENING" box for all patients with routine annual smears with no known previous abnormalities or current visible lesions. For liquid based samples indicate if HPV, GC/Chlamydia or Bacterial vaginosis testing is desired.

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

LIMITATIONS OF THE PROCEDURE:

Air drying is the absence of fixation. Air drying produces artifacts and cellular distortion and may lead to misinterpretation of smears. Air drying of any Pap smear regardless of technique is not recommended. Delayed fixation can also result in air drying artifact.

Any specimen that has been mislabeled or unidentified that has been resubmitted for processing must not be processed until all problems have been rectified, with dates, events, and personnel involved documented on the requisition.

Any slide that is received broken must be documented on the cytology requisition. If portions of the slide can be salvaged, they are to be attached to another glass slide with a spring clip and hand stained. The broken portion is then mounted on a full glass slide with mounting medium and coverslipped.

When coating or spray fixatives are used, the nozzle of the spraying apparatus should be held approximately 8-10 inches from the slide. Holding the spray fixative container too close to the slide can result in cellular artifacts, while holding the spray fixative container too far from the slide may result in drying artifact or uneven fixative.

Clinical Significance

The cervicovaginal (Papanicolaou) smear is a test for detection of premalignant cellular changes which are precursors to carcinoma of the cervix. The Pap smear, when used as part of a regular screening program, has been credited with reducing the incidence of cervical cancer worldwide.

Please note that the Pap smear is a screening test with an irreducible false negative rate. The ability to detect significant disease by cervical screening can be optimized by Pap smear examinations performed at intervals recommend by the American Society for Colposcopy and Cervical Pathology (ASCCP website below http://www.asccp.org/ConsensusGuidelines/tabid/7436/Default.aspx).

Performing Laboratory
Pathology Associates Laboratory (Sierra Pathology)

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.