Cervical screening forum - health.qld.gov.au...HPV Assay • Real-time PCR Test for oncogenic HPV o HPV 16 o HPV 18 o HPV (not 16/18) – includes 31, 33, 35, 39, 45, 51, 52, 56, 58,

Cervical Cancer Screening

Pathology Forum28 November 2017

National Cervical Screening

1. National Cervical Screening Program (NCSP) Renewal

o Pap Smear Cervical Screening Test

HPV Screening

High risk and Positive HPV Liquid Based Cytology (LBC)

2. National Cancer Screening Register (NCSR)

o Replaces state based registers

2Cervical Cancer Screening Pathology Forum

Samples

• Liquid based Cervical samples in PreservCyt (Thin Prep, Hologic)

• Conventional smears NO longer form part of the program

• Do not leave collection device in vial

• Self collect HPV specimens are not currently able to be tested.


Lubricants

• Use of lubricants not recommended

• Residual lubricant may interfere with the collection device in the acquisition of cervical cells

• May cause inhibition in certain molecular based tests including HPV assaysOther substances known to cause PCR inhibition include feminine hygiene

products and Metronidazole vaginal gel.

• Residual lubricant may lead to unsatisfactory cytology results Avoid lubricants containing “Carbomers “or “Carbopol polymers”Forms immiscible interface in alcohol based PreservCyt solution


Labelling

• Specimens: Two (2) separate forms of ID – either Full name and DOB or Full name and UR number

• Keep unlabelled portion of vial free of labels so that the liquid content can be seen

• Request forms: Three (3) separate forms of ID – Full name and DOB, UR number, Address, Medicare number


Collection Do’s and Don’ts

• Do collect the sample before the application of acetic acid • Do keep the unlabelled portion of the sample vial free of labels so that the liquid

contents can be seen • Do not use an endocervical brush in isolation • Do not use the endocervical brush during pregnancy • Do not apply any physician bar-coded labels vertically on the vial, apply them

horizontally • Do not place multiple labels on the outside of the vial • Do not apply any labels over the lid of the container • Do not leave the collection device sitting in the vial whilst attending to the patient• Do not clean the cervix by washing with saline or it may result in an acellular

specimen


Ordering

• To ensure that PQ performs the correct testing the laboratory will need to know

• The indication for testing

o Screeningo Symptomatic ie co-testo Immunosuppressedo Follow up of previous abnormalityo Cervical screening history



Select one only

Select test required

Relevant clinical signs or symptoms and previous significant history

ieMRReferenceWindow


Similar to request form – indicate test(s) required

Select only one

Enter relevant clinical signs or symptoms and previous significant historyinto Clinical Notes or Order Notes in Cerner

Other Request Forms

• If a request form other than the above is used, wording in the request must indicate the tests requested and reasons for testing. Example:

• Cervical Screening Test, Routine (HPV+/- reflex LBC)• Cervical Screening Test, previously unsatisfactory (HPV +/- reflex LBC)• Cervical Co-Test, Symptomatic (HPV + LBC)• Cervical Co-Test, Test of Cure (HPV + LBC)• Cervical Co-Test, Previous AIS (HPV + LBC)• Cervical HPV, follow-up of abnormal test result (HPV +/- reflex LBC)• Cervical Cytology only (LBC) - previous unsatisfactory • Cervical Cytology only (LBC) - previous positive Self-collect


HPV Assay

• Real-time PCR Test for oncogenic HPV

o HPV 16

o HPV 18

o HPV (not 16/18) – includes 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68



Roche Cobas 6800

ß-globin internal cellular control

Liquid Based Cytology

• Monolayer produced by TP5000 processor

• Microscopy examination by screening cytologists and pathologists

• Same process as pap smears but different sample preparation


TP5000 Processor


Screening Pathway



Reports

• Combined HPV and / or LBC report

• Recommendation and “Risk” category based on both HPV and LBC result as per new guidelines


National Cancer Screening Register (NCSR)

• Australian Government initiative

• Will replace the registers operated by each state and territory

• Migration of data from the state based registries to the NCSR to commence early 2018

• Pathology notifications for cervical specimens go to NCSR from 01 Dec 2017

• Opt –off:

o Patient or their medical practitioner must notify NCSR

o Pathology labs can no longer perform this function


Question Time

See also

Pathology Queensland information:• https://www.health.qld.gov.au/qhcss/qhps/cervical-screening

Australian Department of Health information:• http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/healthca

re-providers

Cancer Council information and online training:• https://wiki.cancer.org.au/australia/Guidelines:Cervical_cancer/Screening

Pathology Queensland email for questions and [email protected]


Cervical screening forum - health.qld.gov.au...HPV Assay • Real-time PCR Test for oncogenic HPV o HPV 16 o HPV 18 o HPV (not 16/18) – includes 31, 33, 35, 39, 45, 51, 52, 56, 58,

Documents