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89118
cervical cytological abnormalities. JAMA 2002;287:2120-2129
ThinPrep Diagnostic Without Physician Interpretation
Clinical Information: The ThinPrep PAP Test (TPPT) is an alternative preparation method for the
cervical pap screening test. The method utilizes a liquid-base technique that replaces the direct smear
method of the conventional PAP screen. This method is one of several new technologies developed to
improve visualization of cellular material by reducing smearing trauma, air drying artifact, and obscuring
blood and inflammation. In addition, variability in smearing technique is eliminated as the majority of
processing and preparation is performed in the laboratory under controlled conditions.
Useful For: Routine cytology screen for cervical abnormalities. The method is an alternative to
conventional PAP smears.
Interpretation: Standard reporting, as defined by the Bethesda System (TBS) is utilized.
Reference Values:
Satisfactory for evaluation. Negative for intraepithelial lesion or malignancy.
Note: Abnormal results will be reviewed by a pathologist at an additional charge.
Clinical References: 1. Austin RM, Ramzey I: Increased detection of epithelial cell abnormalities by
liquid-based gynecologic cytology preparations. A review of accumulated data. Acta Cytol
1998;42:178-184 2. Guidos BJ, Selvaggi SM: Use of the ThinPrep PAP test in clinical practice. Diagn
Cytopathol 1999;20:70-73 3. Kurman RJ, Solomon D: The Bethesda system for reporting cervical/vaginal
cytologic diagnoses: definitions, criteria, and explanatory notes for terminology and specimen adequacy.
New York, NY, Springer-Verlag, 1994 4. Gay JD, Donaldson LD, Goellner JR: False-negative results in
cervical cytologic studies. Acta Cytol 1985;29:1043-1046
ThinPrep Screen with HPV for Women 30 Years and Older
Clinical Information: The majority (>99%) of cervical epithelial neoplasms are the result of human
papillomavirus (HPV) infection. "High-risk'' HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and
68) can result in both low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous
intraepithelial lesions (HSIL), as well as invasive carcinomas.(1,2) Patients with both a negative cytology
and negative HPV have been shown to be at extremely low risk for cervical neoplasia.(1,2) For women 30
years old and older who have received a negative Pap test and concurrent negative HPV result, the
American Cancer Society (ACS) and American College of Obstetricians and Gynecologists (ACOG)
recommendations for cervical screening state that physicians may lengthen the screening interval to 3
years when using the combined test. Patients deemed to be high-risk by the clinician should still be
screened more frequently. The presence of high risk HPV types in cervical specimens identifies a
subgroup of patients with a greater likelihood of having a high grade squamous intraepithelial lesion.
Current guidelines for follow up of a cytology-negative/HPV-positive patient recommend repeat HPV
testing in 12 months.(2)
Useful For: Detection of cervical carcinoma or intraepithelial lesions and the presence or absence of
high-risk HPV when screening women over the age of 30 for possible cervical neoplasia
Interpretation: The cytology report issued on gynecologic specimens is an estimate of the nature of
the abnormality using the Bethesda nomenclature.(3) Specimen adequacy is characterized as:
-Satisfactory for evaluation (with quality indicators, if applicable) -Unsatisfactory for evaluation, further
subdivided as follows: --Specimen processed and examined but unsatisfactory for evaluation of epithelial
abnormality because of inadequate cellularity, obscuring blood or inflammation, etc. --Specimen rejected
because of a broken slide, unlabeled specimen, etc. The diagnostic interpretation may include: -Negative
for intraepithelial lesion or malignancy (NIL) -Atypical squamous cells of undetermined significance
(ASCUS) characterized as either: --atypical squamous cells of undetermined significance --atypical
squamous cells, cannot exclude HSIL -Low-grade squamous intraepithelial lesion (LSIL), which includes
mild squamous dysplasia (cervical intraepithelial neoplasia I [CINI]) and koilocytotic changes consistent
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