Pap Test Cytology, Cervical / Vaginal

Specimens may include cervical, cervical/vaginal, endocervical, vaginal and/or vulvar samples. To ensure thorough and complete interpretation of the Pap test, the following pertinent clinical history should be included on the requisition for all Pap tests: specimen source; date of birth; date of last menstrual period (LMP); gynecological surgery/procedures; if patient is pregnant or post-partum; presence of IUD, past or current history of neoplasm, chemotherapy, radiation therapy, abnormal bleeding, previous abnormal Pap tests. Instruct patient to avoid douching for 24-48 hours before examination. THINPREP PAP TEST: Label a ThinPrep vial with the patient's last name, first name and registration number (or other second unique patient identifier). Scrape the cervix circumferentially at the squamocolumnar junction with a plastic spatula. Remove and rinse the spatula as quickly as possible into the ThinPrep vial by swirling it vigorously 10 times in the solution. Discard the spatula. Gently insert the cytobrush into the cervical os until only the bottom-most fibers are exposed. Slowly rotate one quarter or one half turn in ONE direction. DO NOT OVER-ROTATE. Remove the brush and rinse in the ThinPrep vial by rotating the brush in the solution 10 times while also pushing against the vial wall. Swirl the brush vigorously to further release the material. Discard the brush. Store the sample at room temperature. CONVENTIONAL PAP TEST: Cervical scrape and brushing is recommended. Except for evaluation of maturation index and detection of vaginal adenosis, submit only one slide. For routine Pap tests, both the scraping of the squamocolumnar junction and endocervical brushing should be spread onto the same slide. Label the glass slide with the patient's last name, first name and registration number (or other second unique patient identifier) using a graphite pencil (do not use ink, wax or crayon), Gently remove excessive secretion or blood at the cervical os with cotton swab and discard. Scrape the ectocervix circumferentially with a cervical spatula at the squamocolumnar junction and spread the material evenly onto one half of the labeled slide. Gently insert an endocervical brush into the cervical os. Rotate, then remove the brush and spread material evenly on the other half of the slide. It does not matter if the two samples mix together. Fix the slide IMMEDIATELY with spray fixative. Allow spray-fixed slide to dry completely and place into a slide holder. Submit with an appropriately completed requisition, including pertinent patient history. VAGINAL SAMPLE: Obtain the cervical sample as described above and spread it on the slides. Before fixing, obtain a vaginal scraping from the posterior fornix with a cervical spatula. Quickly smear it on the slide (separate from or overlapping the cervical material) and spray fix immediately. For patients that have had a hysterectomy, collect a sample from the vaginal apex; spread the material on a labeled slide and spray fix immediately. If submitting a ThinPrep vial, place the sample directly into the vial. VULVAR OR VAGINAL LESION SAMPLES: Collect sample directly from the lesion and submit as indicated above. VAGINAL ADENOSIS: Collect a scraping from each quadrant of the upper vagina and submit separately from cervical samples. Vaginal specimens should be collected before cervical samples are obtained and the area to be sampled is first swabbed to remove any contaminating secretion from the cervix.