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Gynecologic Pap Test (Image-guided), Liquid-based Preparation and Chlamydia trachomatis, NAA
Diagnose primary or metastatic neoplasm; detect Chlamydia trachomatis
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.
Testing for Chlamydia trachomatis requires special procedures to be used in the processing of the cytology specimen; therefore, testing for these organisms cannot be added on after the specimen has been submitted. The liquid-based cytology specimen must be processed for Chlamydia trachomatis testing.
Any time a transport device used for molecular testing is processed, the chance of cross-specimen contamination increases. Aptima® transports can be placed directly on the analyzer, limiting the possibility of cross-specimen contamination.
Image-guided liquid-based Pap test; nucleic acid amplification (NAA) (Chlamydia)
Cervical cells collected by one of the methods described below.
ThinPrep® vial or SurePath™ vial or ThinPrep® vial or SurePath™ vial with optional additional Aptima® swab collection kit (for Chlamydia)
A minimum volume cannot be determined for the ThinPrep® vial because it varies depending on the cellularity of the specimen. The entire SurePath™ specimen should arrive intact. Specimens collected with the Gen-Probe® Aptima® swab collection kit must arrive intact.
ThinPrep® Vial − Broom or Brush/Spatula:
Broom-like collection technique: Obtain a sample from the cervix using a broom-like device by inserting the brush portion into the cervical os and then rotate the brush five times. Rinse the collection device in the PreservCyt® solution by pushing the brush into the bottom of the vial 10 times, forcing the bristles to bend apart to release the cervical material. As a final step, twirl the brush between the thumb and forefinger vigorously to release additional cellular material. Discard the collection device. Tighten the cap on the ThinPrep® vial so that the torque line on the cap passes the torque line on the vial.
Brush/spatula technique: Insert the brush into the endocervical canal until only the bottommost fibers are exposed. Slowly rotate the brush 1/4 to 1/2 turn in one direction. Do not over-rotate the brush. Then, rotate the brush in the PreservCyt® solution 10 times while pushing against the wall of the ThinPrep® vial. Swirl the brush vigorously to release additional material. Discard the brush. Obtain an adequate sample from the ectocervix using a plastic spatula. Swirl vigorously in the ThinPrep® vial 10 times and discard the spatula. Tighten the cap on the ThinPrep® container so that the torque line on the cap passes the torque line on the vial.
SurePath™ Vial: When using the SurePath™ vial, the cervical broom must be used for specimen collection. Insert the broom into the cervical os and rotate five times. Place the broom head into the CytoRich™ preservative fluid in the SurePath™ collection vial. Tightly cap the vial.
Optional Dedicated Specimen for Chlamydia: Use the Gen-Probe® Aptima® swab collection kit. (Note: Do not use the Gen-Probe® PACE DNA probe collection kit.) Clean the cervix using the larger, white-shafted swab supplied in the Gen-Probe® Aptima® swab collection kit and discard. Insert the smaller, blue-shafted swab into the cervix and rotate for 10 to 30 seconds to ensure good sampling. Carefully withdraw the blue-shafted swab, avoiding contact with the vaginal mucosa. Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the transport tube. Break the swab shaft at the scoreline, using care to avoid splashing contents. Recap the swab specimen transport tube tightly.
Causes for Rejection
Improper collection; inadequate specimen; improper labeling; specimen leaked in transit; quantity not sufficient for analysis; name discrepancies; specimen submitted on male patient; specimen submitted in vial that expired according to manufacturer's label; frozen specimen. For Pap: liquid-based cytology specimen more than 21 days old. For Chlamydia trachomatis: liquid-based cytology specimen more than seven days old; Aptima® specimen more than 60 days old; Gen-Probe® Aptima® collection tube with multiple swabs, white-shafted cleaning swab, or any swab other than the blue-shafted collection swab.
Include 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 cytology 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.)
|Order Code||Order Code Name||Order Loinc||Result Code||Result Code Name||UofM||Result LOINC|
|197676||Pap IG, Ct||019018||.||11546-9|
|197676||Pap IG, Ct||019030||.||N/A|
|197676||Pap IG, Ct||019031||Patient Counseling Report||N/A|
|197676||Pap IG, Ct||186114||Chlamydia, Nuc. Acid Amp||50387-0|
|197676||Pap IG, Ct||190109||Note:||N/A|
|197676||Pap IG, Ct||190120||.||N/A|
|197676||Pap IG, Ct||191107||Clinical history:||22636-5|
|197676||Pap IG, Ct||191108||DIAGNOSIS:||22637-3|
|197676||Pap IG, Ct||191109||Specimen adequacy:||19764-0|
|197676||Pap IG, Ct||191110||Additional comment:||22638-1|
|197676||Pap IG, Ct||191111||Recommendation:||19773-1|
|197676||Pap IG, Ct||191112||Performed by:||19767-3|
|197676||Pap IG, Ct||191113||Electronically signed by:||19769-9|
|197676||Pap IG, Ct||191121||Test ordered:||N/A|
|197676||Pap IG, Ct||191123||Maturation index:||N/A|
|197676||Pap IG, Ct||191124||Amended report:||N/A|
|197676||Pap IG, Ct||191125||Addendum:||22639-9|
|197676||Pap IG, Ct||191128||QC reviewed by:||N/A|
|197676||Pap IG, Ct||191129||Cytology history:||N/A|
|197676||Pap IG, Ct||191139||Special procedure:||N/A|
|197676||Pap IG, Ct||191144||QA comment:||N/A|
|197676||Pap IG, Ct||191145||Diagnosis provided by:||N/A|
|197676||Pap IG, Ct||191154||Source:||19763-2|
|197676||Pap IG, Ct||191157||Pathologist provided ICD9:||52797-8|
|197676||Pap IG, Ct||191160||Clinician provided ICD9:||52797-8|
|197676||Pap IG, Ct||191166||Interpretation||N/A|
|197676||Pap IG, Ct||191167||Photomicrograph||N/A|
|197676||Pap IG, Ct||191169||Infection:||N/A|
|197676||Pap IG, Ct||191170||Category:||N/A|
|197676||Pap IG, Ct||191172||Adequacy:||N/A|
|197676||Pap IG, Ct||191173||Recommendation:||N/A|
|197676||Pap IG, Ct||191174||Clinician provided ICD10:||52797-8|
|197676||Pap IG, Ct||191175||Pathologist provided ICD10:||52797-8|
|197676||Pap IG, Ct||191179||Previous history:||N/A|
|197676||Pap IG, Ct||000000||Test Methodology:||47527-7|
|Reflex Table for Test Methodology:|
|Order Code||Order Name||Result Code||Result Name||UofM||Result LOINC|
|Reflex 1||192555||Change IG Pap to LB Pap||000000||LBP CPT Code Automation||47527-7|