A separate, completed AP/Surgical Pathology Request Form must be submitted with each specimen.
The name and location of the physician who submits the specimen should be on the form so that laboratory personnel will know whom to contact.
The revised AP/Surgical Pathology Request Form are available online in Adobe® Acrobat® format (.pdf files). They can be completed onscreen and printed out, or they can be printed out blank and completed by hand.
*You'll need a recent version of the free Adobe® Reader® to open and use the forms. Contact your technical support person if you need help installing the application to open the form.
Specimens should be sent without unnecessary delay to the laboratory. Each specimen container (not just the lid) must bear the addressograph imprint or a handwritten label. Specimens which are improperly collected, grossly contaminated, or unlabeled cannot be accepted and will be returned to sender. For Pap tests, the patient's name should be written in pencil on the end of slide, or, if liquid-based, on the vial. Relevant clinical information should be provided with each specimen, as indicated on the AP/Surgical Pathology Request Form.
Criteria for Specimen Rejection
In order to provide high-quality patient care, the laboratory will not process contaminated specimens, or those with insufficient identification.
While the laboratory will make every effort to gather the information needed to complete improperly filled-in request forms, specimen processing will be delayed if proper paperwork does not include the following information:
- Unlabeled or incorrectly labeled specimens or slides.
- Container label which does not match name on request form.
- Request form contaminated by specimen.
- Lack of minimum information on request form, e.g.:
- Type of specimen
- Date and time of specimen collection
- Patient's full name
- Insurance information
- Submitting physician
Female Genital Specimens
- Pap smears should be taken prior to the routine pelvic examination.
- Douching and application of jellies should be withheld for 24 hours prior to taking the specimen since water or jellies destroy cellular detail.
- All instruments should be clean and dry.
Liquid Based Pap Test (LBP) is the preferred method, but conventional smears are acceptable as well. Call (336) 716-2561 to obtain SurePath Test Packs. Follow these four steps for sample collection:
- Collect the cervical sample: Insert the Rovers Cervex-Brush into the endo-cervical canal. Apply gentle pressure until the bristles form against the cervix. Maintaining gentle pressure, hold the stem between the thumb and forefinger, and rotate the brush five times in a clockwise direction.
- Preserve the entire sample: Placing your thumb against the back of the brush pad, simply disconnect the entire brush from the stem as you drop it into the SurePath preservative vial.
- Cap and label vial: Place the cap on the vial and tighten. Label the vial and lab request form with patient name, date, and physician name.
- Send vial to the lab: Place the entire vial and AP/Surgical Pathology Request Form into a specimen bag and send to the laboratory.
HPV Human Papillomavirus testing is available currently by PCR. With Liquid Based Paps (LBPs), the original sample may be used. To order up front, mark the "HPV Testing" box on the request form. If ordered after the report is issued, send a fax request with name and accession number. Standing order reflex HPV testing (if interpretation is "atypical squamous cells") is available with written request from clinician. Fax to (336) 716-7595.
Reports are available on Last Word.
Conventional Smears are acceptable though LBP samples are preferred. Frosted-end slides are recommended for all smears. The patient's name should be written across the frosted end using a lead pencil. All slides must be labeled.
Cervical Smear: Take smear with a cervical scraper, either wooden or plastic. One end of the scraper is somewhat longer than the other so that it fits the external os. Rotate the scraper using the longer end as a pivot within the external os. Spread on slide and fix immediately.**
Endocervical Smear: Take endocervical smear with special brush rotating slightly. Spread on slide and fix immediately.**
Endometrial Smear: If cancer of the endometrium is suspected, prepare a smear by aspiration from the uterine cavity and fix immediately. **
Vaginal Smear: Take vaginal smear with wooden spatula or cotton swab, scraping the vaginal wall very lightly. Spread on slide and fix immediately.** For hormonal evaluation the smear should be taken from the proximal upper portion of the lateral vaginal wall, carefully avoiding contamination with material from the cervix. Spread on slide and fix immediately.**
**Female genital specimens smeared on slides should be fixed with an aerosol fixative, e.g., Spray-Cyte:
Immediately after preparing the smear(s), spray the slide(s) at a distance of 6-8 inches. Apply enough spray so that the slide(s) is bathed completely by the fixative. Apply the spray while the smear is still moist.
FNA Specimens (Fine Needle Aspirations)
The preparation methods differ slightly depending on whether or not the specimen will be sent through the mail. The Laboratory offers limited courier service within the Winston-Salem area (call 336-716-2616 or 336-716-2615 to schedule a pick-up).
Within Winston-Salem, NC:
We recommend that three preparations be made from the aspirate material. Each preparation consists of a pair of air-dried and alcohol-fixed slides. All six slides must be labeled with the patient's last name.
- Three slides should be air dried and placed in cardboard/plastic slide holders. These will be stained with the Diff-Quik stain in the laboratory.
- Three slides should be fixed in alcohol while the sample is still wet. This is necessary to preserve the cellular features needed for cytomorphologic interpretation. Immerse the slides
- immediately in the green-topped slide holders containing 95% alcohol.
- Rinse the needle in 50% ethanol. Label the container with the patient's name.
- Package for courier pick-up by placing the slide holders and rinse in biohazard bag(s); attach the completed AP/Surgical Pathology Request Form to the outside of the bag.
- Call the courier service to pick up the specimen within Winston-Salem: 336-716-2616 or 336-716-2615.
Outside Winston-Salem (Mail or FedEx):
We recommend that three preparations be made from the aspirate material. Each preparation consists of a pair of air-dried and alcohol-fixed slides. All six slides must be labeled with the patient's last name. The number of slides will, of course, depend on the number of needle passes and the amount of cellular material obtained in each pass.
- Three slides should be air-dried and marked with an "A." These will be stained with the Diff-Quik stain in the laboratory.
- Three slides should be fixed in alcohol while the sample is still wet. This is necessary in order to preserve the cellular features needed for cytomorphologic interpretation. Immerse the slides immediately in 95% ethyl alcohol (80% isopropanalol may be used instead). Allow to remain in the alcohol for 30 minutes. Remove from alcohol and air dry before mailing. These three slides should be marked with an "F;" they will be stained with the routine "Papanicolaou" stain in the laboratory.
- Place all six slides in plastic/cardboard holders and put into biohazard bag(s). Attach completed request form* to the outside of the bag.
- Put the bags in a cardboard mailing tube or FedEx box. Gauze, tissue, or bubble-wrap around the slides will help to protect them.
- Address the package as follows:
Wake Forest Baptist Medical Center
Medical Center Boulevard
Winston-Salem, NC 27157
Attention: Cytology Laboratory
Reports are typed in the AP Information Center. Once the diagnosis is complete and signed by the pathologist, results are available for inquiry and printing via UPLink.
The Laboratory uses the new Bethesda 2001 Terminology for reporting Pap Test results, and reminds providers of cervicovaginal specimens that the Pap Test is a screening test for cervical cancer with an inherent false negative rate.
False negative results may occur due to sampling problems, screening difficulties inherent in smears with small numbers of abnormal cells, or due to the subjective nature of cytologic interpretation. Please remind your patients to consult you immediately if they experience any new symptoms.