A Pap smear examines the cells of the cervix and detects cell abnormalities. Both, cancerous and precancerous cells can be detected. Pap tests are recommended in women ages 21 - 64, every two years with normal Pap results. Vaginal Pap smears can also be performed but must be noted on the requisition.
Collection and Transportation: In general, the ideal time to perform a Pap test is more than 12 days after the last menstrual period and 24 hours or more after douching or sexual intercourse. Perform the test before a bimanual exam. The proper technique for a conventional Pap smear, using the scrape and cytobrush and/or swab, is as follows:
- Place the patient in the lithotomy position.
- Using an unlubricated vaginal speculum (saline may be used as a lubricant) visualize the cervix as fully aspossible. Be sure the slide being used is already labeled in pencil with the proper patient information and site of sample. Label the slide(s) with the patient’s first and last name, date of birth, and specimen source directly on the frosted end of the glass, in pencil, before beginning the procedure. The laboratory will not accept unlabeled slides. A rare patient may have 2 cervices and then designate as right or left.
- If on visual inspection, the cervix is coated with excessive mucus, inflammatory debris, blood or other contaminants, lightly dab the surface with a salinemoistened 4x4 or swab to remove obscuring substances that will make the smear unsatisfactory for interpretation without disturbing the surface epithelium.
- After visualization of the cervix is accomplished, insert the cytobrush into the endocervical canal and rotate it half a turn. Withdraw the cytobrush and spread the collected material quickly and evenly onto the half of the slide opposite the frosted end. The endocervical mucus will prevent air-drying during collection of the subsequent cervical component.Using the extended-tip spatula, scrape material with the spatula from the whole circumference of the cervix (in a 360° turning motion). Withdraw the spatula and spread the collected material quickly and evenly onto the half of the slide adjacent to the frosted end. Fix the specimen immediately by dropping the slide into fixative or spraying it with fixative, holding the spray bottle approximately 8 to 12 inches from the slide. Complete the cytology test request form, including relevant clinical information.
The importance of immediate and generous fixation with Pap fixative cannot be overstated. The smear should be left on a level surface (not at an angle) and allowed to dry if spray-fixed.
If an accurate hormonal assessment is necessary (MI), a lateral vaginal wall scraping should be submitted separately. Do not submit for hormonal assessment if there is clinical evidence of active inflammation.
- Avoid using KY Jelly lubricant on the speculum (Use warmed water instead.). Be mindful that powder from gloves doesn’t contaminate the specimen or glass slides. If using powdered gloves rinse them after placing on your hands under running water.
Send the smear to the laboratory in a protective slide holder, along with the matched requisition properly inserted in biohazard bag. The laboratory will proceed with the staining, screening and review of the specimen by a cytotechnologist and/or pathologist, according to established guidelines. Do not place thick mucus plugs on the Pap slide, as this interferes with staining and obscures important cellular detail.
Reference: 4th Edition of Koss pg. 6
Storage/Transport Temperature: Submit specimens according to Biological Substance, Category B, shipping guidelines.
- Incomplete requisition (especially the federally required indication for the procedure)
- Broken slides fragmented beyond repair
- Incomplete and/or improper labeling of slides
- Insufficient pertinent clinical history
- Specimens that are not immediately fixed on a slide
- Obscuring inflammation, debris or excessive air drying
- Broken slides, which will be rejected and discarded as a biohazard
Always record if a cytobrush was used to obtain the Pap test. Failing to record the use of a cytobrush may result in erroneous atypical results for the patient.
Stability (collection to initiation of testing):
- Ambient: Indefinitely
- Frozen: Unacceptable
- Refrigerated: N/A