Gynecologic Pap Test (Image-guided), Liquid-based Preparation and Chlamydia/Gonococcus, NAA

CPT: 87491; 87591; 88175
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Special Instructions

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.)


Expected Turnaround Time

2 - 5 days



Related Documents

For more information, please view the literature below.

Microbiology Specimen Collection and Transport Guide


    Specimen Requirements


    Specimen

    Cervical cells collected by one of the methods described below.


    Volume

    ThinPrep® vial or ThinPrep® vial with optional additional Aptima® swab collection kit (for Chlamydia/Gonococcus)


    Minimum Volume

    A minimum volume cannot be determined for the ThinPrep® vial because it varies depending on the cellularity of the specimen. Specimens collected with the Gen-Probe® Aptima® swab collection kit must arrive intact.


    Container

    ThinPrep® vial or ThinPrep® vial and Aptima® swab collection kit (for Chlamydia/Gonococcus)


    Collection

    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 ¼ to ½ 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.

    Optional Dedicated Specimen for Chlamydia and Gonococcus: 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.


    Storage Instructions

    Maintain liquid-based cytology and Aptima® swab transport specimens at room temperature. Pap processing must be done within 21 days of collection. Liquid-based cytology specimens must be tested within seven days for Chlamydia/Gonococcus; if the Aptima® swab transport is used, it must be tested within 60 days.


    Patient Preparation

    Patient should avoid douches 48 to 72 hours prior to examination. Specimen should not be collected during or shortly after menstrual period.


    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; SurePath™ vial. For Pap: liquid-based cytology specimen more than 21 days old. For Chlamydia trachomatis and Neisseria gonorrhoeae: 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.


    Test Details


    Use

    Diagnose primary or metastatic neoplasma; detect Chlamydia trachomatis and Neisseria gonorrhoeae


    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.

    Testing for Chlamydia trachomatis and Neisseria gonorrhoeae 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 and Neisseria gonorrhoeae 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.


    Methodology

    Image-guided liquid-based Pap test; nucleic acid amplification (NAA) (Chlamydia/Gonococcus)


    References

    Centers for Disease Control and Prevention. Screening test to detect Chlamydia trachomatis and Neisseria gonorrhoeae−2002. MMWR. 2002; 51(RR15). 12418541
    Hutchinson ML, Cassin CM, Ball HG 3rd. The efficacy of an automated preparation device for cervical cytology. Am J Clin Pathol. 1991 Sep; 96(3):300-305. 1877527
    Hutchinson ML, Isenstein LM, Goodman A, et al, Homogeneous sampling accounts for the increased diagnostic accuracy using the ThinPrep® Processor. Am J Clin Pathol. 1994 Feb; 101(2):215-219. 8116578
    Joseph MG, Cragg F, Wright VC, Kontozoglou TE, Downing P, Marks FR. Cyto-histological correlates in a colposcopic clinic: A 1-year prospective study. Diagn Cytopathol. 1991; 7(5):477-481. 1954825
    Wilbur DC, Cibas ES, Merritt S, James LP, Berger BM, Bonfiglio TA. ThinPrep® Processor. Clinical trials demonstrate an increased detection rate of abnormal cervical cytologic specimens. Am J Clin Pathol. 1994 Feb; 101(2):209-214.8116577

    LOINC® Map

    Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
    196402 Pap IG, Ct-Ng 47527-7 191121 Test ordered: N/A
    196402 Pap IG, Ct-Ng 47527-7 191108 DIAGNOSIS: 47528-5
    196402 Pap IG, Ct-Ng 47527-7 191166 Interpretation 19764-0
    196402 Pap IG, Ct-Ng 47527-7 191170 Category: N/A
    196402 Pap IG, Ct-Ng 47527-7 191173 Recommendation: N/A
    196402 Pap IG, Ct-Ng 47527-7 191169 Infection: N/A
    196402 Pap IG, Ct-Ng 47527-7 191172 Adequacy: N/A
    196402 Pap IG, Ct-Ng 47527-7 191111 Recommendation: 19773-1
    196402 Pap IG, Ct-Ng 47527-7 191109 Specimen adequacy: 19764-0
    196402 Pap IG, Ct-Ng 47527-7 191154 Source: 19763-2
    196402 Pap IG, Ct-Ng 47527-7 191160 Clinician provided ICD9: 52797-8
    196402 Pap IG, Ct-Ng 47527-7 191174 Clinician provided ICD10: 52797-8
    196402 Pap IG, Ct-Ng 47527-7 191107 Clinical history: 22636-5
    196402 Pap IG, Ct-Ng 47527-7 191124 Amended report: N/A
    196402 Pap IG, Ct-Ng 47527-7 191110 Additional comment: 22638-1
    196402 Pap IG, Ct-Ng 47527-7 191125 Addendum: 22639-9
    196402 Pap IG, Ct-Ng 47527-7 191123 Maturation index: N/A
    196402 Pap IG, Ct-Ng 47527-7 191112 Performed by: 19767-3
    196402 Pap IG, Ct-Ng 47527-7 191128 QC reviewed by: N/A
    196402 Pap IG, Ct-Ng 47527-7 191145 Diagnosis provided by: N/A
    196402 Pap IG, Ct-Ng 47527-7 191113 Electronically signed by: 19769-9
    196402 Pap IG, Ct-Ng 47527-7 191139 Special procedure: N/A
    196402 Pap IG, Ct-Ng 47527-7 191129 Cytology history: N/A
    196402 Pap IG, Ct-Ng 47527-7 191179 Previous history: N/A
    196402 Pap IG, Ct-Ng 47527-7 191144 QA comment: N/A
    196402 Pap IG, Ct-Ng 47527-7 019018 . 11546-9
    196402 Pap IG, Ct-Ng 47527-7 191157 Pathologist provided ICD9: 52797-8
    196402 Pap IG, Ct-Ng 47527-7 191175 Pathologist provided ICD10: 52797-8
    196402 Pap IG, Ct-Ng 47527-7 190120 . N/A
    196402 Pap IG, Ct-Ng 47527-7 190109 Note: N/A
    196402 Pap IG, Ct-Ng 47527-7 000000 Test Methodology: 47527-7
    196402 Pap IG, Ct-Ng 47527-7 186114 Chlamydia, Nuc. Acid Amp 50387-0
    196402 Pap IG, Ct-Ng 47527-7 186122 Gonococcus, Nuc. Acid Amp 50388-8
    196402 Pap IG, Ct-Ng 47527-7 019054 PDF N/A
    196402 Pap IG, Ct-Ng 47527-7 191167 Photomicrograph N/A
    196402 Pap IG, Ct-Ng 47527-7 019030 . N/A
    196402 Pap IG, Ct-Ng 47527-7 019031 Patient Counseling Report N/A
    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

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