Cervical specimens are taken as part of the NHS cervical screening programme (NHSCSP). Approximately 105,000 cervical cytology requests are processed by the cytology laboratory each year with specimens being processed from practices in the Brighton & Hove CCG, Coastal West Sussex CCG, Horsham and Mid Sussex CCG, Crawley CCG, Eastbourne, Hailsham and Seaford CCG, High Weald Lewes and Haven CCG, Hastings and Rother CCG and East Surrey CCG areas.
Since 1st January 2011 98% of cervical cytology specimens should be reported within 14 days of the specimen being taken.
The cytology department implemented NHSCSP, Human Papilloma Virus (HPV) Triage and Test of Cure pathways in August 2013. The HPV test is performed within the Cytology department at BSUH.
Information on the cervical screening programme including a number of publications can be found onwww.gov.uk/government/collections/cervical-screening-professional-guidance and http://www.cancerscreening.nhs.uk/cervical.
The laboratory is part of the South: Screening Quality Assurance Service (SQAS).
All personal information received is covered by the Data Protection Act. All staff within the department have received confidentiality training. Personal information is recorded on a secure computer system only accessible by laboratory staff.
When receiving a cervical specimen, it is important that sufficient relevant clinical information is given. Relevant clinical information includes:
- Date of last specimen.
- Whether the patient is pregnant/post natal.
- Details of any hormones including contraception.
- IUCD in situ.
- Any symptoms of abnormal bleeding.
- Any previous abnormal specimens.
- Any previous treatment.
This will help in the interpretation of the cervical specimen and also ensure that the correct follow up management is given.
Individuals taking cervical specimens must have attended a specimen taker course and completed their training logbook. Before taking specimens they must register as specimen takers with the Screening and Immunisation team (PHE).
A cervical sample taking resource pack and toolkit should be available within GP practices and hospital clinics for guidance on taking the specimen.
By presenting herself for cervical screening, the patient has consented to the procedure. Once the specimen is taken, the head of the sampling device (cervical broom) must not be left within the vial. The vial must be labelled with the patient’s surname, forename and date of birth and/or NHS number. Ensure that the lid on the vial has been tightened.
Please note that use of a vaginal lubricant e.g. Replens may affect HPV testing leading to an inadequate result.
Clinical advice from Consultant Pathologist/Consultant BMS is available. Please telephone during normal working hours.
All cervical cytology specimens should be accompanied with a pre-populated form. Forms can be downloaded via Open Exeter but the preferred method of requesting is via ICE requesting.
Please ensure that your unique cytology specimen takers PIN code is recorded on the request form. This is constantly monitored within the laboratory and information is shared with the regional screening and immunisation leads. Please note that you should not use another person’s PIN code or allow another person to use yours.
There should be a minimum of three legible and correct patient identifiers to link a form and vial that arrive together. There should be a minimum of three legible and correct patient demographics to identify a patient and match them with any existing record on the pathology system.
Insufficient labelling of request forms and/or specimen vials may result in disposal of the specimen. When a specimen is disposed of there is a wait period of at least 12 weeks before a repeat sample can be taken - this is in order to allow the cervical epithelium to regenerate.
Errors relating to specimens taken as part of the cervical screening programme are recorded and reported to Screening and Immunisation leads and the Hospital Based Screening Coordinator.
The department follows the NHS Cervical Screening Programme Guidance for acceptance of cervical screening samples in laboratories and pathways, roles and responsibilities: PHE publications gateway number:2016704, published April 2017.
The main points are:
- Unlabelled vial (these are always rejected as we cannot confirm which patient the vial belongs to – please take extra care)
- Broom in vial
- Insufficient patient identifiers between vial and form
- Mismatched vial and form
- Woman aged under 24 years and 6 months
- Woman aged over 65 years
- Vault samples from GPs (these are only accepted from Gynae & Colp clinics)
- Forms without vials
- Vials without forms
- Samples received too early after a previous test (please check Open Exeter if you are unsure whether the patient is due for her test)
- Vial in poor condition - leaked vial, out of date vial, damaged vial
- Samples must be received in Preservcyt and not in any other fixative e.g Formalin
These may lead to the sample being rejected of discarded. The sample taker will be informed by letter or report of these samples. If you require any further information, please contact the department as above.
Vials containing the cervical cytology specimen must be labelled with the patients surname, forename and date of birth and/or NHS number. A HMR101 pre-populated request form must be completed via Open Exeter or ICE with full patient information and history. Requests will be accepted on handwritten HMR101 forms but please remember to include previous screening history.
The request form and specimen vial should be placed in a specimen bag and then sent to the laboratory ASAP to facilitate 14 day turnaround times. Samples taken on a Friday afternoon will keep over the weekend at room temperature.
The screening intervals set by NHSCSP for routine samples in England are:
- Aged 25-49: every 3 years
- Aged 50-64: every 5 years
Routine recall is indicated by ‘A’ on the HMR101 form.
Patients with a prior abnormality should have repeat tests as recommended – these will be given the code ‘R’ on the HMR101 form.
Patients with a negative HPV result may be given the ‘R’ code due to a recommended repeat of 36 months – this ensures the patient is called back for a repeat test as follow-up in 3 years, but is not deemed as a ‘normal recall’.
When a patient has a suspended recall, indicated by an ‘S’ code, they have been under the care of colposcopy and the follow-up interval should be provided by colposcopy.
Please check ‘Cervical Cytology Reports’ on Open Exeter which will show the true recall date and may have further information in the ‘notes’ section.
Please note: samples must not be taken less than 12 weeks after an inadequate result.
Human Papilloma Virus (HPV) is known to be associated with cancer of the cervix. Testing for high risk HPV can help to decide at an early stage which women should be referred to a hospital clinic for further investigation (and possible treatment) and which women could be safely returned to routine screening without the anxiety of repeat screening tests.
The laboratory uses the Roche cobas® HPV test which are automated qualitative in vitro tests for the detection of human papillomavirus (HPV) DNA in patient specimens. The tests utilize amplification of target DNA by the polymerase chain reaction (PCR) and nucleic acid hybridization for the detection of 14 high-risk HPV (hrHPV) types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) in a single analysis.
Cervical cell specimens are collected in PreservCyt® Solution for cytological assessment. Following the NHS Cervical Screening Programme protocol algorithm for HPV triage and TOC, the sample is tested for high risk HPV if required in the pathway, with a minimum volume of 3 mL needed for an hrHPV test.
|hrHPV Positive:||Positive for 1 or more of the 14 high-risk types listed above.|
|hrHPV Negative:||Negative for all of the 14 high-risk types listed above.|
|hrHPV Unavailable:||Issue with the sample meaning a definitive result could not be generated.|
Factors that could affect test performance or interpretation
- Insufficient volume of sample available
- Low cellularity
- Heavily blood stained samples due to excessive blood clots
Laboratories to which work is routinely referred:
The Department of Cytopathology
The Cotman Centre
Norfolk and Norwich University Hospitals
NHS Foundation Trust
If you have any complaints about the service the department provides please contact the Head BMS on 01273 664414.
Patients should contact Patient Advice and Liaison Service (PALS).