Cervical Screening

This section contains information for Registered Nurses (RNs) performing Cervical Cancer Screening.

This section contains information and resources for when your patient has an abnormal Pap result, and resources for colposcopy.

This section contains clinical information and resources for Colposcopy.

This section contains information and resources for unsatisfactory results.

What does an unsatisfactory Pap result mean?

This means the test was rejected/not processed by the laboratory or that the specimen was processed and examined but was unsatisfactory for evaluation of epithelial abnormality or the cells could not be seen well enough to give a result.

Why is it important?

The ACCSP monitors quality and performance indicators in the cervical cancer screening pathway. One of these is the unsatisfactory rate. The provincial target is <1%.

Causes

Unsatisfactory Pap test results are mostly due to cervical sampling and specimen collection issues. This may be due to a number of factors which includes:

1. Scant cellularity.
2. Faulty technique.
3. Post-menopausal status.
4. Excess lubricant use.
5. Interfering substances like mucus, blood and bacteria.
6. Human error such as:

• Unlabeled specimens: Name and unique identifier missing.
• Incorrect or mislabeled specimens: For example, patient details (name or different patient ID) on requisition form and sample container don’t match.
• Identifier incomplete: Missing fields like first or last name missing, initials only, missed numbers on patient’s PHN.
• Significant misspelling where more than 2 letters are transposed or missing/added, letters that changes the interpretation of the name.
• The use of incorrect containers or preservatives.
• Test request received without a corresponding sample or vice versa.
• Sample container not properly sealed leading to loss of sample.

What happens after an unsatisfactory result?

Every unsatisfactory Pap leads to a repeat Pap test in 3 months.

What can I do to reduce my unsatisfactory rates?

Patient related:

• Book their appointments for a day they won’t be on their periods (but should book an appointment if they have an abnormal bleeding). Wait at least 7 – 10 days after first day of menstrual period.
• Prepare your patients for their Pap test by informing them about the following:

1. Avoid douching or using contraceptive creams, vaginal medicines, sprays, powders or jellies in the 48 hours before the test.
2. Avoid sexual intercourse in the 24 hours before the test.
3. Avoid the use of personal lubricants in the 48 hours before the test.
4. Avoid having a Pap test when you are being treated for cervical or vaginal infections. Wait at least 2 weeks after treatment ends before having a Pap test.

Physician related

• Collect samples far enough into endocervical canal to obtain cells.
• Follow manufacturer’s instructions for transferring the sample from the instrument to the liquid medium.
• Use lukewarm water for speculum lubrication.
• If clinically indicated or for patient’s comfort, use dime sized carbomer free lubricants.
• Provide all relevant clinical information on laboratory requisition forms.

Manufacturers’ guides

• APL: ThinPrep Gynecological Pap Specimen Collection Quick Reference Guide (albertahealthservices.ca)
• DynaLife: BD SurePath collection instructions.pdf (dynalife.ca)

Resources

APL

• Sample Acceptance Policy: Acceptance of Laboratory Samples and Test Requests Policy (albertahealthservices.ca)
• Gyneacological Cytopathology Requisition Completion Aid: PCYSCR00003 Gynecological Cytopathology Requisition Completion Aid (albertahealthservices.ca)
• Label Placements: PA17-02.010 Laboratory Specimens – Label Placement (albertahealthservices.ca)

DynaLife

• Requisition Completion Aid: Requisition completion minimum requirements.pdf (dynalife.ca)
• Gyneacological Cytopathology Requisition Completion Aid: Gyne Requisition Completion Guide (dynalife.ca)
• Label Placements: Specimen Submission Criteria (dynalife.ca)