Hormonal Evaluation (Maturation Index) on Conventional/ThinPrep Method

A separate lateral vaginal wall smear/specimen is required. Note: Please provide clinical diagnosis when making a request for a maturation index. Also, in some cases a maturation index may not be performed due to certain conditions such as: cellular atypia, excessive inflammation, blood, bacteria, and specimens that are representative of another anatomic source.

  • No implement for pap smear collection allows a 100 percent cancer detection rate.
  • Detection may be impeded by hyperkeratosis, parakeratosis, polyps, necrosis and normal epithelium covering the lesion, as well as excessive blood, inflammatory exudates, bacteria, or other limiting conditions that might obscure cellular details.
  • All specimen requirements must be met.
  • Pap smears only occasionally detect endometrial cancers and rarely detect ovarian malignancies.

Specimen requirements:

  • Cervix must be visible.
  • Slide(s) must have patient’s name printed on them.
  • Cleanse cervix of excessive lubricant, exudates, blood, and mucus with a swab or gauze to avoid obscuring of the cells collected.
  • Smear(s) should be pancervical representing 360° of endo/ectocervix (transitional zone).
  • Smear(s) must represent an adequate number of cells, not too thick (cells obstructing cells) or too thin.
  • Smear(s) must be well fixed immediately.

Supplies needed:

Speculum, gloves, ayre spatula/endocervical brush, cotton swabs/gauze, labeled glass slide(s), slide carrier, fixative spray, cytology requisition form.

Procedure:

  • Obtain supplies. A combination of spatula and endocervical brush are recommended.
  • Insert the speculum. Cleanse surface of ectocervix with swab or gauze, removing excessive mucus, exudates, blood, or other debris that can obscure the collected cells.
  • Introduce the spatula tongue into the cervical canal so that its "shoulder" rests at the ectocervix.
  • Rotate the spatula 360° using slight, but constant pressure so that it always remains in contact with ecto and endocervical mucosa.
  • Spread cells along the long axis of the slide. If uneven, the same spatula may be used for quick re-spreading.
  • Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the brush into the cervix until only the bottom most fibers are exposed. Slowly rotate one-quarter or half turn in one direction. DO NOT OVER-ROTATE. Note: For one-slide technique, thinly spread cells collected from ectocervix, and endocervix over the same slide.
  • Immediately fix the slide with fixative spray.

For Non-Pregnant Patients:

  • Insert the endocervical brush into the endocervix until only the bristles closest to the handle are visible.
  • Slowly rotate one half to one full turn. Remove.
  • Prepare the smear by rolling the brush across the glass slide.
  • Immediately spray fix the smear.
  • Discard the brush and spatula.
  • When fixative is dry, place slide in the slide carrier.
  • Complete the cytology requisition including patient name and date of birth, physician’s name, source of specimen (e.g. endo and ectocervix), LMP, clinical findings, pertinent patient history (e.g., surgery, hormonal status, etc.) and previous pap results.

The ThinPrep Pap Test, for the detection of cancerous and pre-cancerous cells, can be collected by using either the Endocervical Brush/Spatula procedure or the Broom-like device procedure.

Specimen requirements:

  • Cervix must be visible.
  • PreservCyt vial must have patient name printed on container label.  
  • Sample should be pancervical representing 360° of endo/ectocervix.
  • Specimen must be immediately placed in the PreservCyt vial and rinsed properly.
  • Specimen must represent an adequate number of cells.

Supplies Needed:

Speculum, gloves, plastic spatula/endocervical brush or broom-like device, cotton swabs, PreservCyt solution vial, cytology requisition, and specimen bag.

ThinPrep Collection Procedure using the Endocervical Brush/Spatula:

  • Obtain supplies.
  • Insert the speculum. Cleanse surface of ectocervix with cotton swab, removing the mucus and debris.
  • Introduce the plastic spatula tongue into the cervical canal, so that it’s "shoulder" rests at the ectocervix.
  • Rotate the spatula 360° using slight, but constant pressure so that it always remains in contact with ecto and endocervical mucosa (transitional zone).
  • Rinse the spatula as quickly as possible into the PreservCyt solution vial by swirling the spatula vigorously in the vial 10 times.
  • Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the brush into the cervix until only the bottom most fibers are exposed. Slowly rotate one-quarter or half turn in one direction. DO NOT OVER-ROTATE.
  • Rinse the brush as quickly as possible in the PreservCyt Solution by rotating the device in the solution 10 times while pushing against the PreservCyt vial wall. Swirl the brush vigorously to further release material. Discard the brush.
  • Tighten the cap so that the torque line on the cap passes the torque line on the vial.
  • Record the patient’s name on the vial and fill in all patient information and medical history on the cytology requisition form.
  • Place the vial and requisition in a specimen bag for transport to the laboratory.

ThinPrep Collection Procedure using the Broom-like Device:

  • Obtain supplies.
  • Insert the speculum. Cleanse surface of ectocervix with cotton swab, removing mucus and debris.
  • Obtain an adequate sampling from the cervix using a broom-like device. Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix. Push gently, and rotate the broom in a clockwise direction five times.
  • Rinse the broom as quickly as possible into the PreservCyt Solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the broom vigorously to further release material. Discard the collection device.
  • Tighten the cap so that the torque line on the cap passes the torque line on the vial.
  • Record the patient’s name on the vial and fill in the patient information and medical history on the cytology requisition form.
  • Place the vial and requisition in a specimen bag for transport to the laboratory. Reference: Part No. 85217-001 Rev. E, 2000, Cytyc Corporation

Note: Cytyc Corporation has provided Sparrow Laboratories with a Quick Reference guide that gives a visual representation of the sample collection technique. If you would like a copy of the Reference Guide please contact the Cytology department at 517.364.2010.

Results are usually available in two to seven business days. All reports are described using the Bethesda 2001 standardized reporting system. Each finalized report returned to the requesting physician provides the electronic signature of the evaluator, and date of reporting.