Gynaecological Cytology

Written by Robert Storer Created on Updated on .

Gynaecological Cytopathology

(cervical screening)

Obtaining your sample taker PIN

Each sample taker must use their own unique sample taker PIN number for taking cervical samples.  These are NOT transferrable and must never be shared.

To obtain a sample taker PIN you must contact the cytology department email your request to

This email address is being protected from spambots. You need JavaScript enabled to view it. whereby you will be required to complete an application form and provide evidence of current full training in the collection of ThinPrep LBC samples.

Instructions for taking a ThinPrep (Hologic)

Liquid Based Cytology (LBC)

The Cytology Department uses ThinPrep (Hologic) liquid based technology

These samples must only be taken by appropriately trained and registered sample takers.

·         Obtain an adequate sample from the cervix using a Rovers Cervex broom. 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 five times. DO NOT adapt the sampling device or the LBC kit in anyway. Any adaptations will invalidate the test.

 

·         Rinse the broom as soon as possible into the PreservCyt Solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles to splay. As a final step, swirl the broom vigorously to further release the material. Discard the collection device according to local clinical waste guidance.

·         Tighten the sample vial cap so that the torque line on the cap passes the torque line on the vial to minimise the risk of spillage and potential loss of sample.

·         In the event that a sample vial is spilt,

For full NHSCSP guidelines for taking cervical screening samples please refer to: http://www.cancerscreening.nhs.uk/cervical/publications/nhscsp23.html

Gynae sample labelling

Record the patient's name PID/NHS number and/or DOB legibly on the specimen vial using a permanent marker pen.  Adhesive patient labels may also be used but must not impede the opaque band round the vial wall which allows visualisation of sample volume. For clinical governance reasons, a minimum of the full patient name and one other matching identifier are required for acceptance by the laboratory.

Completion of the gynae request form (HMR101)

The use of pre-populated HMR101 A5 (2009) request forms from the Open Exeter system is strongly encouraged. These forms can be downloaded from the Open Exeter website. Complete all remaining sections of the HMR101 request form fully and legibly using ball point pen, providing as much relevant clinical information as possible. In the event that a pre-populated request form cannot be obtained, the option to print a blank HMR101 form is available from the Open Exeter website.

Further information on completion of the HMR101 request form can be obtained on the NHS Cervical Screening website or visiting the links below:-

http://www.cancerscreening.nhs.uk/cervical/hmr101.html

http://www.cancerscreening.nhs.uk/cervical/hmr101-2003-version.pdf

Mandatory Information

·        Patient identifiable details (name, date of birth, address, NHS number)

·        NHS number is essential in the event that the woman requires referral for colposcopic assessment in order that an appointment can be made.

·        Sender details including GP location code

·        Sample-taker PIN number. Obtaining missing PIN numbers takes valuable laboratory time and may lead to significant delays in the reporting process, potentially compromising the mandatory 14 day turnaround time.

·        Date the sample was taken.

 

Specific Instructions for the transport of Gynae Specimens

The NHSCSP guidelines state that 98% of women will receive the results of their screening tests within 14 days of the test date.  Thus, it is essential that samples are transported to the laboratory as soon as possible to ensure the turnaround target set is achieve. This is particularly important when samples are taken prior to a weekend or bank holiday. 

After labelling, samples should be placed in an individual HEFT PINK plastic transport bag and sealed using the incorporated fastener. DO NOT secure with pins, staples, etc. DO NOT place the request form in with the sample but in the integral side pocket to avoid contamination in the event of a spillage. Place the individually bagged samples into the larger pink coloured plastic cytology transport bags and seal ready for transport to the cytology laboratory for processing. Sealing the transport bags will minimise the risk of loss of samples during transport to the laboratory and protect couriers from any spillages that may occur.

LBC Spillage

In the event of a spillage of an LBC Cervical sample DO NOT attempt to salvage any material lost as this may have become contaminated. In addition, DO NOT top up the fluid with another PreservCyt vial.  Due to the bactericidal and virucidal nature of the LBC transport medium, there should be no biohazardous element. Mop up any specimen spillage using absorbent material and place in Clinical waste bag. Swab contaminated area with household detergent. Record that there has been a spillage on the HMR101 form and send the sample to the laboratory. The specimen will be processed and evaluated for abnormal cells. If no abnormal cells are seen then the sample will be reported as inadequate due to the potential loss of diagnostic cellular material during the spillage.  In the event that the entire sample is lost, another sample must not be taken until after a minimum of 3 months to allow the epithelium to regenerate.

For further information on ThinPrep liquid based cytology visit the Hologic website www.hologic.com

Non-Acceptance Policy

As part of NHS Improvement a national zero tolerance policy was recommended to reduce resource waste and facilitate compliance with the 14 day turn around target. It is based upon NHS Improvement publication "Cytology improvement guide - achieving a 14 day turnaround time in cytology", published November 2009. The document can be downloaded from NHS Cancer Screening Programmes website.

In accordance with this policy, samples will be rejected for the following reasons:

  • Mislabelled/ mismatching sample vials/ request forms (i.e. incorrect patient demographic information)
  • Unlabelled samples
  • Incorrect or missing patient demographic information on request forms/ sample vials.
  • Samples taken outside of the scope of the NHS Cervical Screening Programme (women under 25, over 64 or women without a cervix due to previous total abdominal hysterectomy).
  • Inappropriate samples e.g. those taken prior to invitation from Call/ Recall services regardless of the presence or absence of clinical symptoms.

The laboratory will endeavour to provide CCGs and individual practices/ clinics with feedback regarding specimen rejections/ defects every 6 months or as requested.

For further information visit:www.wmciu.nhs.uk - Information resources “West Midlands Regional Acceptance Policy for Cervical Cytology Samples”

Key factors affecting the performance of the examination or the interpretation of results

The following list details some of the measures you can take to prevent compromising the performance of cervical cytology screening and leading to sample rejection or a delay in reporting.

  • Ensure that samples are sent to the laboratory as soon as possible and are sent in SEALED PINK cytology transport bags to ensure that the samples are delivered to the correct department for processing without delay.
  • Ensure that the vial is labelled – all unlabelled sample vials are automatically rejected.
  • Mislabelled samples/ request forms can result in the sample being either rejected or a delay in reporting times.
  • When completing the request form please inform the department of any relevant screening history or clinical information. 
  • Please check the expiry dates of the LBC Kits prior to use. Samples received in out of date vials will be processed, however, if no abnormality is detected, they will be considered suboptimal and will be reported as unsatisfactory.  In the event that an abnormality is present, the sample will be reported based on the cytological findings alone.  These samples are not eligible to be tested for the presence or absence of high risk HPV.
  • Taking out of scope or inappropriate specimens will result in the sample being rejected. (e.g. women under 25, Women over 64 and women without a cervix due to previous total abdominal hysterectomy).
  • Missing sample- taker codes will result in a delay in reporting. Every effort is made to obtain sample-taker PIN; however, if it transpires that the sample has been taken by an untrained sample- taker or if the correct sample-taker PIN is unobtainable, the sample will be reported as inadequate if no abnormality is detected.

Interpretation of results

If you need advice or require interpretation of results please contact the department           Tel: 0121 424 41191.

HPV Testing of LBC Samples

Birmingham Heartlands Cytology Department commenced HPV (Human Papilloma Virus) testing as part of the NHS Cervical Screening Programme from Monday 1st October 2012.

HR-HPV testing is performed for cytology by the Public Health England, Public Health Laboratory Birmingham, on the Heartlands Hospitalsite.

 

HPV testing is performed in accordance with the NHSCSP Guidance:

  • HPV ‘Test of Cure’ - any negative or low grade cervical screening sample taken within follow-up period after treatment for CIN or complete excision of CGIN.
  • HPV Triage – on all Borderline/Low grade abnormalities

 

All cervical screening sample takers should have already received HPV training packs via their PCT Cervical Screening Coordinators.

Further information about the cervical screening programme and HPV testing can be found on the NHS Cervical Screening Programme Website please click the link below:

 

HPV triage and test of cure protocol flowchart July 2014

More information about HPV and cervical screening

 

Reporting times

In line with NHS Cervical Screening Programme (NHSCSP) Guidelines - 98% of cervical screening results should be available within 14 days of the date of collection. 

 Further examination on LBC samples is possible but will only be carried out following discussion with a Consultant Pathologist. Samples are kept for a minimum of 48 hours after the final report has been issued.  Stained slides are archived for 10 years.

Further information on Cytology 14 day Turnaround can be found at:

http://www.cancerscreening.nhs.uk/cervical/14-tat.html