Alberta Precision Laboratories

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Organization:	Alberta Precision Laboratories

Test Name/Synonym:	Gynecological Cytology (Synonym: PAP, Pap Test, Pap Smear, Liquid-based Pap, Pap Cytologic Exam)
Clinical Indications:	Cells from the Cervix or Vagina, also known as Pap smears, are collected as a screening test for detection of cellular abnormalities of cervical pre-cancer and cancer. Testing is not recommended for patients less than 21 years of age unless clinically indicated per TOP Cervical Cancer Screening Clinical Practice Guideline.
Collection Alert:	For ThinPrep® collections only: Lubricants interfere with cell preservation and processing of the specimen. Specimens received contaminated with lubricant will be rejected. Specimens received with brush in vial will be rejected.
LABID (Connect Care):	LAB4

Specimen Type:	Liquid based Cytology
Specimen Source:	Cervix, Vagina
Primary Container:	Testing at Diagnostic and Scientific Centre (DSC): ThinPrep® Pap Collection Kit Testing at Edmonton Base Lab (EBL): BD SurePath™ Pap Vial
Specimen Collection Requirements:	Patients should refrain from using personal lubricants and douching one week prior to specimen collection. Pre-lubricated disposable speculums may interfere. Ensure the lubricant does not contact the area to be sampled. Luke warm water is preferred to warm and lubricate the speculum. If water-soluble lubricant must be used, lubricant may be applied to the speculum only, avoiding the tip. Appropriate Use of Lubricant-ThinPrep® Pap Specimen Collection Mucous globs should be removed from the cervix prior to sampling. Blot the mucous plug with a cotton tipped applicator at the os. Collect specimen prior to any acetic acid visualization technique. Specimen collection should be avoided during heavy menstrual bleeding. For BD SurePath^TM Collection and Submission instructions, refer to Cytology-Pap smear and collection videos resource. Collection Option1 Broom-Type Device: The ectocervical and endocervical specimens are collected simultaneously with the Broom-Type detachable head device. Insert the central bristles of the device into the endocervical canal until the lateral bristles fully bend against the ectocervix. Maintaining gentle pressure, the broom is then rotated in a clockwise direction 360 degrees for a total of five (5) times. NOTE: It is important NOT to reverse the direction of the rotation, as this will remove the cellular material from the bristles. Drop the detachable head of the device into the larger opening of the labelled BD SurePath^TM vial. Place the cap on the vial and tighten to prevent leakage during transportation. Place the labelled vial in a biohazard bag and seal. Place the completed req in the outer pocket of the biohazard bag. Send the sealed biohazard bag containing the specimen and req to the laboratory for processing. Collection Option #2 Combination Brush/Spatula: The ectocervical sample is collected with the Pap Perfect plastic spatula, then the endocervical sample is collected with the Cytobrush Plus GT, both with detachable heads. Insert the contoured end of the Pap Perfect plastic spatula and rotate 360 degrees around the entire cervix. Snap the handle at the scoring line and drop the detachable head of the device into the larger opening of the labelled BD SurePath^TM vial. Place cap on the vial. NOTE: Do not tighten cap until step 4 Insert Cytobrush Plus GT into the endocervix until only the bottom-most bristles are exposed at the os. Slowly rotate ¼ to ½ turn in one direction. To reduce unnecessary bleeding, do not over-rotate brush. Snap the device handle at the red scoring line and drop the detachable head of the device into the larger opening of the labelled BD SurePath^TM vial. Place the cap on the vial and tighten to prevent leakage during transport. Place the labelled vial in a biohazard bag and seal. Place the completed req in the outer pocket of the biohazard bag. Send the sealed biohazard bag containing the specimen and req to the laboratory for processing. For ThinPrep® collection instructions refer to ThinPrep® Quick Reference Guides and ThinPrep Pap Test Specimen Collection \| Hologic Note: Avoid lubricants and DO NOT leave brush in vial. Collect ectocervical cells using the ectocervical spatula Place the spatula with the longer ‘wing’ toward the entrance of the cervix Rotate the spatula 360 degrees so that at the end of the rotation the cells will be on top of the spatula i.e., if the spatula is rotated clockwise, start and finish at the 9 o’clock position; if the spatula is rotated counterclockwise, start at the 3 o’clock position Rinse the spatula in the ThinPrep® vial swirling vigorously 10 times Discard spatula Collect endocervical cells using the endocervical brush Insert the brush into the cervix until only the bottom-most bristles are visible Rotate ¼ to ½ turn Rinse the brush in the ThinPrep® vial swirling vigorously 10 times with a ‘mashing’ action against the inside wall of the vial If the specimen seems mucoid and appears stuck to the brush, use the spatula to gently scrape the material from the brush and dislodge into the vial Discard brush Tighten the cap so the black markings on the cap are past the markings on the vial. Place the labelled vial in a biohazard bag and seal. Place the completed req in the outer pocket of the biohazard bag. Send the sealed biohazard bag containing the specimen and req to the laboratory for processing.
Test Resources:	Requisition: Gynecological Cytopathology Requisition - 21815 Gynecological Cytopathology Requisition Completion Aid Toward Optimized Practice Cervical Cancer Screening Clinical Practice Guideline: Cervical-cancer-screening-guideline.pdf To order SurePath^TM and ThinPrep®, access the lab supply ordering portal. Eligible community providers can email cpsmoperations.eoc@albertahealthservices.ca or, if urgent, call 1-833-613-5289.
Processing:	Place collected specimen in a sealed biohazard bag. One specimen per bag. Place requisition in outside pouch. Ensure that microbiology specimens are sent in separate bags along with the microbiology requisitions.
Method:	Liquid Based Cytology (LBC)
Routine Turn Around Time:	Within 15 working days

Testing Schedule:	Monday to Friday

Testing Area:	Cytopathology

Performing Site:	Edmonton Base Lab (EBL) Diagnostic and Scientific Centre (DSC)
Additional Test Information:	Reflex HPV Testing can be performed on the same sample following eligibility criteria. For more information on Reflex HPV Testing refer to the HPV testing pamphlet found at Screening for Life.ca

Last Updated On:	Thursday, March 20, 2025
Registered Trademark Comments:	ThinPrep^® is a registered trademark of Hologic SurePath^TM is a registered trademark of BD

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