Liquid-based ThinPrep Paps vs. Conventional Pap Smears
In 2001, our lab processed over 8,000 paps by a new liquid-based technology. Clinicians prepare conventional "pap smears" by smearing the cervical cell sample directly on a glass slide and then spray-fixing the cells. With the new liquid-based technology, the clinician instead places the cervical cell sample directly into a vial of fixative solution, and then a thin layer of cells is created in the lab with a Thin Prep processing machine. This allows for a more uniform layer of cells, better preservation, with less obscuring by blood and inflammation. The other benefit of this new technology is that HPV and other ancillary testing can be performed from the vial of remaining specimen.

For more information click on the following links:
Cytyc Corp and ThinPrep.

HPV Test
Pacific Rim Pathology is pleased to announce the implementation of a new HPV testing and reporting (Oct. 2006).

As part of our goal to increase turnaround time and ease of reporting HPV results, Pacific Rim Pathology has adopted the Digene HPV testing format. We will be reporting the presence or absence of High Risk HPV. We will no longer comment on the low risk HPV types. This FDA approved test will allow a more rapid turnaround time and an easier to read report.

HPV High Risk
Specific HPV genotypes have been show to be associated with certain anogenital diseases. The HPV high-risk probe targets DNA of HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68.
Test Method: Hybrid Capture 2 by Digene Corporation of Gaithersburg, Maryland.

[An FDA approved in-vitro nucleic acid hybridization assay with signal amplification for the qualitative detection of Human Papilloma Virus (HPV) types from primary and ThinPrep sources. ACOG recommends HPV by Hybrid Capture II for primary screening (in conjunction with a cervical smear) for women over 30 years of Age. HPV by Hybrid Capture II is helpful in the assessment and evaluation of ASCUS cervical smears to help determine if increased surveillance of colposcopy is needed.]
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For managing women with ASCUS, reflex HPV DNA testing is now the preferred approach when liquid-based cytology is used. (Reference and/or link to Consensus Guidelines and Algorithms.) HPV testing reveals whether the patient has high-risk or low-risk HPV types. For HPV testing on ThinPrep samples, the specimen should be less than 20 days old, and at least 10cc should be remaining in the vial. For HPV testing on Digene samples, the specimen should be less than 4 weeks old. When an HPV test is requested, the office will receive a separate report.

ThinPrep® Method for Collection of GYN (Pap Smear) Specimens
(from "ThinPrep® Pap TestTM Quick Reference Guide", 1997, Cytyc Corporation)

General notes:
1) The specimen should not be taken during menstruation. Douching prior to the exam and lubricants should be avoided.
2) The cervical transformation zone should be thoroughly sampled in a patient with a cervix.
3) The pap smear (conventional or ThinPrep) is a screening procedure to aid in the detection of cervical cancer and its precursors. Both false positive and false negative results are known to occur.

Broom-like device protocol:
1) 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.
2) Rinse the broom in the PreservCyt Solution vial by pushing the broom into the bottom 10 times, forcing the bristles apart. As a final step, swirl the broom vigorously to further release material. Discard the collection device.
3) Tighten the cap so that the torque line on the cap passes the torque line on the vial, label with patient's name, and send in a plastic bag with completed requisition form.

Endocervical brush/spatula protocol:
1) Obtain an adequate sampling from the ectocervix using a plastic spatula.
2) Rinse the spatula in the PreservCyt Solution vial by swirling the spatula vigorously 10 times. Discard the spatula.
3) 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 ¼ or ½ turn in one direction. DO NOT OVER-ROTATE.
4) Rinse the brush in the PreservCyt Solution by rotating the device 10 times while pushing against the vial wall. Swirl vigorously. Discard the brush.
5) Tighten the cap so that the torque line on the cap passes the torque line on the vial, label with patient's name, and send in a plastic bag with completed requisition form.