Gynecologic Pap Smear, One Slide, Two Slides

CPT: 88164 (each test)
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Test Details

Synonyms

  • Cervical/Vaginal Smear
  • Genital Cytology
  • Papanicolaou Smear
  • Vaginal Cytology

Use

Diagnose primary or metastatic neoplasms; diagnose genital infections with herpesvirus, Candida, Trichomonas vaginalis, cytomegalovirus, Actinomyces, cervicovaginal endometriosis, human papillomavirus (HPV), and lymphogranuloma venereum; aid in evaluating hormonal function (maturation index) in vaginal specimens

Limitations

Failure to obtain adequate ectocervical, endocervical, or vaginal cell population is suboptimal for evaluation. Excessive use of lubricating jelly on the vaginal speculum will interfere with cytologic examination and may lead to unsatisfactory Pap results. All powder should be wiped off gloves before spatulas are handled since presence of starch granules will make interpretation of slides difficult. Inflammatory reaction may preclude hormonal evaluation. A very significant proportion of adenocarcinomas of endometrium are not detected by this means. Occasionally, highly differentiated adenocarcinomas of endocervix can be missed. Occasional aggressive lesions of squamous epithelium of cervix can be missed, especially if patient has only a single examination.

Methodology

Pap stained: microscopic examination

Specimen Requirements

Specimen

Endocervical brush and cervical scrape are recommended in all cases. Aspiration of posterior vaginal fornix (vaginal pool) may also be used but is not a substitute for cervical specimens. Endometrial aspirations are not advised for routine use. For lesions of the vagina or vulva, scrapings made directly from lesion are desirable. Scraping of upper one-third of lateral vaginal wall is most suitable for hormonal evaluation.

Container

Slides and other supplies, including cytospray fixative, slide holders, and request forms are available from courier service. Commercial Pap collection kits are also available.

Patient Preparation

Patient should avoid douches 48 to 72 hours prior to examination. Specimen should not be collected during or shortly after menstrual period. Excessive use of lubricating jelly will interfere with cytologic examination.

Collection

Preferred fixative: Cytospray fixative or 95% ethyl alcohol.

Patient identification of specimen: Each Vaginal Cervical Endocervical (VCE) slide must be labeled with patient name and origin of site, written with graphite pencil on frosted end of slide. Nonfrosted end should be labeled with diamond point pen.

Sampling − Endocervix: Cervical aspiration or brush of endocervical canal

• Endocervical smear is prepared by inserting endocervical brush into endocervical canal and rotating the brush. Spread material onto labeled glass slide and fix immediately with spray fixative.

• Ectocervical scrape: With spatula, thoroughly scrape the entire ectocervix with emphasis on the squamocolumnar junction. Spread material evenly onto labeled glass slide and fix immediately.

• Vaginal smear: If vaginal smear is desired, obtain specimen by lightly scraping the posterior fornix with spatula. Spread material evenly onto labeled glass slide and fix immediately. (Make cell spread from the vaginal pool first: fix slide immediately, then make cell spread from the cervix and fix the slide immediately before collecting the endocervical specimens.)

• Vaginal smear for hormonal evaluation, obtain cells from the upper third of the lateral vaginal wall. Spread material evenly onto labeled glass slide and fix immediately.

Fixation: If more than one slide is immersed in fixation solution, attach a paper clip to each slide to separate slides and allow adequate fixation. Spray fixation with cytospray fixative is preferred.

Processing: Place slides in cardboard holders or fixative jars and include completed test request form and secure.

Storage Instructions

Maintain specimen at room temperature. Slides may be stored indefinitely when spray fixed.

Causes for Rejection

Improper labeling; fixation in formalin; air-drying artifact

Clinical Information

Special Instructions

Include patient's name, date of birth, Social Security number (or other identification number), previous malignancy, drug therapy, radiation therapy, last menstrual period (LMP), postmenopausal patient (PMP), surgery (including surgical biopsies), exogenous hormones, abnormal vaginal bleeding, abnormal Pap results, IUD, and all other pertinent clinical information on the test request form.

Note: In accordance with criteria established by CLIA, Pap tests will be referred for pathologist review if laboratory personnel suspect:

• Reactive or reparative cellular changes

• Atypical squamous or glandular cells of undetermined significance

• Cells in the premalignant or malignant category

In these cases, LabCorp will charge for the associated service. (Slides that are routinely reviewed by a pathologist for quality control purposes are not included.)

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