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Cytology results and recommendations

  1. The cytology result is negative but the recommendation is to ‘refer to colposcopy’ - why?
  2. The cytology result is negative but the recommendation is to ‘refer to gynaecology’ - why?
  3. The cytology reports states ‘expired’ and recommends repeat in 3 months – why?
  4. Why is there a requirement to wait for three months to repeat a smear test for a sample that was reported as expired or inadequate?
  5. Should the result and management recommendations on the cytology reports be checked?
  6. A comment on the report states that the smear test pattern is predominantly parabasal - what does this mean?
  7. There is a comment regarding endometrial cells seen in a negative smear test, what is the significance of this?
  8. The cytology report indicates TZ cells absent but the woman has still received a negative result with routine re-call – why?
  9. Will women get a reminder for an early repeat smear test (3 or 6 months)?

The cytology result is negative but the recommendation is to ‘refer to colposcopy’ - why?

If the Suspicious Cervix box is ticked on the Cervical Cytology Form that accompanies the sample, the laboratory is required to make the recommendation to refer to colposcopy. Clinical suspicion will always override a smear test, as the smear test is a screening test with unavoidable false negative/positive results. If there is clinical suspicion, smeartakers should not wait for a cytology result before making a referral to gynaecology.

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The cytology result is negative but the recommendation is to ‘refer to gynaecology’ - why?

If abnormal bleeding is indicated on the Cervical Cytology Form that accompanied the sample, the laboratory is instructed to make the recommendation to refer for gynaecological assessment (clinical correlation is suggested).

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The cytology reports states ‘expired’ and recommends repeat in 3 months – why?

Expiry of vial: The expiry date of the vial is determined by the manufacturer. Laboratories do not process samples taken in expired vials. When ordered, smear test kits have at least 18 months before expiry. Rotating the stock of smear test kits – always using the earliest received – avoids expired vials.

Vials should be sent at least 10 days prior of the expiry date to allow for transit and processing at the laboratory.

Expiry of sample: The manufacturer's specification for the smear test kit determines how long a sample remains valid for processing after being taken. Samples should be despatched to the laboratory at least once per week. This will avoid expiry of samples.

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Why is there a requirement to wait for three months to repeat a smear test for a sample that was reported as expired or inadequate?

Taking a smear test before three months can result in a sub-optimal sample.

'The cervical epithelium needs time to regenerate after cytology. Repeat cytology should not be performed less than three months after a previous pap smear' (European Guidelines for Quality Assurance in Cervical Cancer Screening - 6.3.1).

'There must be a minimum of 3 months between any 2 smear tests' (NCSS CervicalCheck Guidelines for Quality Assurance in Cervical Screening – Standard 3-12).

Samples of repeat smear tests taken before the three months has lapsed will not be processed by the laboratory. The cytology report will state 'repeated too soon', with a recommendation to repeat after three months.

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Should the result and management recommendation on cytology reports be checked?

Yes, it is recommended to check that the text description reads correctly on the result and that the management recommendation is correct for the woman’s history.

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A comment on the cytology report states that the smear test pattern is predominantly parabasal - what does this mean?

Parabasal cells are immature squamous cells seen on the cervix in the absence of oestrogen. They are often seen in post menopausal or post natal women or in those who are taking a progesterone only pill. It is not a cytological abnormality.

 

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There is a comment regarding endometrial cells seen in a negative smear test, what is the significance of this?

Bethesda reporting for cytology results requires the laboratory to note the presence of endometrial cells in an otherwise negative smear test in women over 40 years as there is a very small chance of this indicating endometrial adenocarcinoma. It should be interpreted clinically based on the woman’s menstrual history and examination.

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The cytology report indicates TZ cells absent but the woman has still received a negative result with routine re-call – why?

Transformation Zone (TZ) cells are not required to be present to deem a smear test as adequate. An absence of TZ cells does not affect re-call in an adequate negative smear test. If a negative result is given, the routine re-call recommendation should be followed.

However, smeartakers should be aware that evidence of TZ sampling is considered to be a measure of smeartaking competency. Trainees on CervicalCheck smeartaker training courses are expected to reach a TZ sampling rate of 80 per cent of smear tests taken (in an audit of a minimum of 30 adequate smear test results). CervicalCheck cytology reports which use Bethesda terminology provide a comment on the presence or absence of TZ cells.

Note that it may be more difficult to sample the TZ in post menopausal women.

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Will women get a reminder for an early repeat smear test (after 3 or 6 months)?

CervicalCheck issues a letter to a woman following a smear test. The letter, for unsatisfactory or abnormal (low grade) results, will advise her to make an appointment for a repeat smear test in 3 or 6 months as appropriate.

CervicalCheck does not send a separate letter of reminder in advance of the repeat smear test due date.

Note that failsafe (abnormal follow up) letters will be sent to both the woman and to the doctor if notification of the repeat smear test is not received by CervicalCheck within 2 months of the due date.

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Is cuid den tSeirbhís Náisiúnta Scagthástála é CervicalCheck
Bosca Oifig Phoist 161, Luimneach
Saorghlao 1800 45 45 55
CervicalCheck is part of the National Cancer Screening Service
PO Box 161 Limerick
Freephone 1800 45 45 55

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Is cuid den Rannóg Sláinte agus Folláine i bhFeidhmeannacht na Seirbhíse Sláinte í an tSeirbhís Náisiúnta Scagthástála. Cuimsíonn sí BreastCheck – An Clár Náisiúnta Scagthástála Cíoch, CervicalCheck – An Clár Náisiúnta Scagthástála Ceirbheacs, BowelScreen – An Clár Náisiúnta Scagthástála Putóige agus Diabetic RetinaScreen – An Clár Náisiúnta Scagthástála Reitiní do Dhiaibéitigh.

The National Screening Service is part of the Health and Wellbeing Division of the Health Service Executive. It encompasses BreastCheck – The National Breast Screening Programme, CervicalCheck – The National Cervical Screening Programme, BowelScreen – The National Bowel Screening Programme and Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme.