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Gynecologic Pap Smear, One Slide, Two Slides, and Maturation Index
- Pap Smear and Maturation Index
Diagnose primary or metastatic neoplasma; diagnose genital infections with herpesvirus, Candida, Trichomonas vaginalis, cytomegalovirus, and Actinomyces; aid in the diagnosis of vaginal adenosis, cervicovaginal endometriosis, human papillomavirus (HPV), lymphogranuloma venereum; aid in evaluating hormonal function (maturation index); evaluate cellular composition of the surface layers of vaginal squamous epithelium, which reflects balance of estrogen and progesterone effects upon this target tissue; diagnose conditions producing abnormal cytohormonal balance (ie, pituitary dysfunction, ovarian dysfunction, feminizing tumor, and virilizing tumor)
Failure to obtain adequate ectocervical, endocervical, or vaginal cell population renders the specimen 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.
Pap stained: microscopic examination
009209: cells from lateral vaginal wall; 190074: cells from cervix, endocervix, vaginal pool, lateral vaginal wall
009209 (one slide), 190074 (two slides)
Cardboard or plastic slide holder(s), Coplin jar(s)
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.
For 009209, submit one slide with cells from lateral vaginal wall. For 190074, submit two slides: the first with cells from the cervix, endocervix, and vagina; the second with cells from the upper one-third of the lateral vaginal wall. Fix slides immediately in 95% ethyl alcohol or with spray fixative. Write the patient's name on the frosted end of the slides. Using a graphite pencil, identify the smear of the lateral wall slide by writing “LW” on the frosted end of the slide. Nonfrosted end of slide should be labeled with a diamond point pen.
Maintain specimen at room temperature. Slides may be stored indefinitely when spray fixed.
Causes for Rejection
Improper labeling; failure to obtain lateral vaginal wall specimen; fixation in formalin; air-drying artifact
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 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.)