Hospital & Surgical Centers

Chlamydia DNA Detection

Methodology

Real Time-PCR

Turn Around Time (TAT)

4 days

Test Description

The cobas® CT/NG Test is an automated, in vitro nucleic acid amplification test for the qualitative detection of Chlamydia trachomatis (CT) DNA in urogenital specimens.

Clinical Significance

Infection with Chlamydia trachomatis (CT) is the most frequently reported bacterial sexually transmitted disease (STD) in the United States. CT can cause urethritis, cervicitis, proctitis, conjunctivitis, endometritis, and salpingitis; if left untreated, the infection may ascend to the uterus, fallopian tubes, and ovaries causing pelvic inflammatory syndrome, ectopic pregnancy, and tubal factor infertility. Reiter’s syndrome (urethritis, conjunctivitis, arthritis, and mucocutaneous lesions) has also been associated with genital CT infection. Many infections remain asymptomatic, and high numbers of infected patients may not seek care.

Specimen Requirements

Urine (First catch, preferred), Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Urine Collection for Male and Female (using Cobas PCR Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Patients should not have urinated for at least one hour prior to specimen collection.
Direct the patient to collect first-catch urine (approximately 10 to 50 mL of the initial urine stream) into a urine collection cup. The collection of larger volumes of urine may reduce test sensitivity.
The first catch urine should be immediately transferred into the cobas PCR Media tube using the provided disposable pipette. (Note: If the urine specimen cannot be transferred immediately, it can be stored at 2°C to 30°C for up to 24 hours.)
The correct volume of urine has been added when the fluid level is between the two black lines on the tube label.
Re-cap the cobas urine specimen transport tube tightly. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 30 days of collection.

B: Vaginal swab – Clinician collection

Note expiry date on sample collection vial. Do not use expired vials.
Collect: In one hand, hold the woven swab with the scoreline above your hand and insert the swab about 5 cm (2 inches) into the vaginal opening. Gently turn the swab for about 30 seconds while rubbing the swab against the walls of the vagina. Withdraw theswab carefully. Do not let the swab touch any surface before placing it into the collection tube.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Endocervical swab

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Using the woven swab, remove excess mucus from the cervical os and surrounding mucosa. Discard the swab after cleaning. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: To collect the specimen, hold flocked swab with the scoreline above your hand and insert into the endocervical canal. Gently rotate the swab 5 times in one direction in the endocervical canal. Do not over-rotate. Carefully withdraw the swab, avoiding any contact with the vaginal muscosa.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

D: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls the brush vigorously to further release material. Discard the the brush.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

E: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

A: Urine Collection

Patients should not have urinated for at least one hour prior to specimen
Female patients should not cleanse the labial area prior to collecting
If the collected urine contains excess blood (specimen has a dark red or brown color) it should be discarded and not used for testing.

Unacceptable Specimen Conditions

Urine specimens with more than 24 hours of collected without transferred to cobas PCR media. Urine specimen with volume under or above the black lines, specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

Gonorrhea DNA Detection

Methodology

Real Time-PCR

Turn Around Time (TAT)

4 days

Test Description

The cobas® CT/NG Test is an automated, in vitro nucleic acid amplification test for the qualitative detection of Neisseria gonorrhoeae (NG or GC) DNA in urogenital specimens.

Clinical Significance

Infection with Neisseria gonorrhoeae (NG) is the causative agent of gonorrhea. Clinical manifestations of NG infections are numerous. In men; acute urethritis presents itself after a 1- 10 day incubation period with urethral discharge and dysuria. Only a small proportion of men remain asymptomatic without signs of urethritis. Acute epididymitis is the most common complication, especially in young men. In women, the primary site of infection is the endocervix. In symptomatic women increased discharge, dysuria, and intermenstrual bleeding may be observed. Pelvic inflammatory disease can occur in 10%-20% of women, combined with endometritis, salpingitis, tubo ovarian abscess, pelvic peritonitis, and perihepatitis. Other gonococcal infected sites in men and women are the rectum, pharynx, conjunctiva, and to a lesser degree the disease presents itself as disseminated gonococcal infection. Infants from infected mothers can develop conjunctivitis.

Specimen Requirements

Urine (First catch, preferred), Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Urine Collection for Male and Female (using Cobas PCR Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Patients should not have urinated for at least one hour prior to specimen collection.
Direct the patient to collect first-catch urine (approximately 10 to 50 mL of the initial urine stream) into a urine collection cup. The collection of larger volumes of urine may reduce test sensitivity.
The first catch urine should be immediately transferred into the cobas PCR Media tube using the provided disposable pipette. (Note: If the urine specimen cannot be transferred immediately, it can be stored at 2°C to 30°C for up to 24 hours. )
The correct volume of urine has been added when the fluid level is between the two black lines on the tube label.
Re-cap the cobas urine specimen transport tube tightly. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 30 days of collection.

B: Vaginal swab – Clinician collection

Note expiry date on sample collection vial. Do not use expired vials.
Collect: In one hand, hold the woven swab with the scoreline above your hand and insert the swab about 5 cm (2 inches) into the vaginal opening. Gently turn the swab for about 30 seconds while rubbing the swab against the walls of the vagina. Withdraw theswab carefully. Do not let the swab touch any surface before placing it into the collection tube.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Endocervical swab

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Using the woven swab, remove excess mucus from the cervical os and surrounding mucosa. Discard the swab after cleaning. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: To collect the specimen, hold flocked swab with the scoreline above your hand and insert into the endocervical canal. Gently rotate the swab 5 times in one direction in the endocervical canal. Do not over-rotate. Carefully withdraw the swab, avoiding any contact with the vaginal mucosa.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

D: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls the brush vigorously to further release material. Discard the the brush.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

E: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

A: Urine Collection

Patients should not have urinated for at least one hour prior to specimen
Female patients should not cleanse the labial area prior to collecting
If the collected urine contains excess blood (specimen has a dark red or brown color) it should be discarded and not used for testing.

Unacceptable Specimen Conditions

Urine specimens with more than 24 hours of collected without transferred to cobas PCR media. Urine specimen with volume under or above the black lines, specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

Gonorrhea RNA Detection

Methodology

Transcription Mediated Amplification (TMA) and Dual Kinetic Assay (DKA).

Turn Around Time (TAT)

4 days

Test Description

The APTIMA Combo 2 Assay is an automated, target amplification nucleic acid probe test that utilizes target capture for the in vitro qualitative detection of ribosomal RNA (rRNA) of Neisseria Gonorrhoeae (NG or GC) in urogenital specimens.

Clinical Significance

Infection with Neisseria gonorrhoeae (NG) is the causative agent of gonorrhea. Clinical manifestations of NG infections are numerous. In men; acute urethritis presents itself after a 1- 10 day incubation period with urethral discharge and dysuria. Only a small proportion of men remain asymptomatic without signs of urethritis. Acute epididymitis is the most common complication, especially in young men. In women, the primary site of infection is the endocervix. In symptomatic women increased discharge, dysuria, and intermenstrual bleeding may be observed. Pelvic inflammatory disease can occur in 10%-20% of women, combined with endometritis, salpingitis, tubo ovarian abscess, pelvic peritonitis, and perihepatitis. Other gonococcal infected sites in men and women are the rectum, pharynx, conjunctiva, and to a lesser degree the disease presents itself as disseminated gonococcal infection. Infants from infected mothers can develop conjunctivitis.

Specimen Requirements

Urine (First catch, preferred), Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Urine Collection for Male (using Aptima PCR Urine Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Patients should not have urinated for at least one hour prior to specimen collection.
Direct the patient to collect first-catch urine (approximately 20 to 30 mL of the initial urine stream) into a urine collection cup. The collection of larger volumes of urine may reduce test sensitivity.
The first catch urine should be immediately transferred into the Aptima PCR Media tube using the provided disposable pipette. (Note: If the urine specimen cannot be transferred immediately, it can be stored at 2°C to 30°C for up to 24 hours.)
The correct volume of urine has been added when the fluid level is between the two black lines on the tube label.
Re-cap the Aptima urine specimen transport tube tightly. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 30 days of collection.

B: Vaginal swab – Clinician collection (using Aptima Unisex Swab Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Collect: Partially peel open the swab package and remove the swab. Remove the blue- shaft specimen collection swab. Do not touch the soft tip or lay the swab down. If you touch the soft tip, use a new APTIMA Combo 2 Unisex Swab Collection Kit.
Carefully insert the blue-shaft swab into the vagina about 2 inches (5 cm) past the introitus and gently rotate the swab for 10 to 30 seconds.
Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab and then withdraw the swab without touching the skin.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Endocervical swab

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Remove excess mucus from the cervical ostium and surrounding mucosa using the cleaning swab (white-shaft swab in the package with red printing). Discard this swab. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: Insert the specimen collection swab (blue-shaft swab in the package with the green printing) into the endocervical canal. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling.
Withdraw the swab carefully; avoid any contact with the vaginal mucosa.
Align: Remove the cap from the Aptima Unisex Swab Media Tube and immediately place the swab into the transport tube so that the score line is at the top of the tube.
Break: Carefully break the swab shaft at the score line against the side of the tube.
Close: Tightly recap the Aptima Swab. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 60 days of collection.

D: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls 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. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 3 months of collection.

E: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

A: Urine Collection

Patients should not have urinated for at least one hour prior to specimen
Female patients should not cleanse the labial area prior to collecting
If the collected urine contains excess blood (specimen has a dark red or brown color) it should be discarded and not used for testing.

Unacceptable Specimen Conditions

Urine specimens with more than 24 hours of collected without transferred to Aptima Urine media. Urine specimen with volume under or above the black lines, specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

Chlamydia RNA Detection

Methodology

Transcription Mediated Amplification (TMA) and Dual Kinetic Assay (DKA).

Turn Around Time (TAT)

4 days

Test Description

The APTIMA Combo 2 Assay is an automated, target amplification nucleic acid probe test that utilizes target capture for the in vitro qualitative detection of ribosomal RNA (rRNA) of Chlamydia trachomatis (CT) in urogenital specimens.

Clinical Significance

Infection with Chlamydia trachomatis (CT) is the most frequently reported bacterial sexually transmitted disease (STD) in the United States. CT can cause urethritis, cervicitis, proctitis, conjunctivitis, endometritis, and salpingitis; if left untreated, the infection may ascend to the uterus, fallopian tubes, and ovaries causing pelvic inflammatory syndrome, ectopic pregnancy, and tubal factor infertility. Reiter’s syndrome (urethritis, conjunctivitis, arthritis, and mucocutaneous lesions) has also been associated with genital CT infection. Many infections remain asymptomatic, and high numbers of infected patients may not seek care.

Specimen Requirements

Urine (First catch, preferred), Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Urine Collection for Male (using Aptima PCR Urine Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Patients should not have urinated for at least one hour prior to specimen collection.
Direct the patient to collect first-catch urine (approximately 20 to 30 mL of the initial urine stream) into a urine collection cup. The collection of larger volumes of urine may reduce test sensitivity.
The first catch urine should be immediately transferred into the Aptima PCR Media tube using the provided disposable pipette. (Note: If the urine specimen cannot be transferred immediately, it can be stored at 2°C to 30°C for up to 24 hours.)
The correct volume of urine has been added when the fluid level is between the two black lines on the tube label.
Re-cap the Aptima urine specimen transport tube tightly. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 30 days of collection.

B: Vaginal swab – Clinician collection (using Aptima Unisex Swab Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Collect: Partially peel open the swab package and remove the swab. Remove the blue- shaft specimen collection swab. Do not touch the soft tip or lay the swab down. If you touch the soft tip, use a new APTIMA Combo 2 Unisex Swab Collection Kit.
Carefully insert the blue-shaft swab into the vagina about 2 inches (5 cm) past the introitus and gently rotate the swab for 10 to 30 seconds.
Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab and then withdraw the swab without touching the skin.
Align: Remove the cap from the Aptima Unisex Swab Media Tube and immediately place the swab into the transport tube so that the score line is at the top of the tube.
Break: Carefully break the swab shaft at the score line against the side of the tube.
Close: Tightly recap the Aptima Swab. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 60 days of collection.

C: Endocervical swab – Clinician collection (using Aptima Unisex Swab Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Remove excess mucus from the cervical ostium and surrounding mucosa using the cleaning swab (white-shaft swab in the package with red printing). Discard this swab. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: Insert the specimen collection swab (blue-shaft swab in the package with the green printing) into the endocervical canal. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling.
Withdraw the swab carefully; avoid any contact with the vaginal mucosa.
Align: Remove the cap from the Aptima Unisex Swab Media Tube and immediately place the swab into the transport tube so that the score line is at the top of the tube.
Break: Carefully break the swab shaft at the score line against the side of the tube.
Close: Tightly recap the Aptima Swab. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 60 days of collection.

D: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls the brush vigorously to further release material. Discard the the brush.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

E: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

A: Urine Collection

Patients should not have urinated for at least one hour prior to specimen
Female patients should not cleanse the labial area prior to collecting
If the collected urine contains excess blood (specimen has a dark red or brown color) it should be discarded and not used for testing.

Unacceptable Specimen Conditions

Urine specimens with more than 24 hours of collected without transferred to cobas PCR media. Urine specimen with volume under or above the black lines, specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

Human Papilloma Virus DNA Detection with genotyping of 16/18

Methodology

Real Time-PCR

Turn Around Time (TAT)

5 days

Test Description

The cobas® HPV high risk Test is an automated, in vitro nucleic acid amplification test for the qualitative detection of HPV in cervical, anal and oral specimens collected by a clinician. The test utilizes amplification of target DNA by the Polymerase Chain Reaction (PCR) and nucleic acid hybridization for the detection of 14 high-risk HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) in a single analysis and specifically identifies types HPV16 and HPV18.

Clinical Significance

The Human Papilloma Virus (HPV) is a small, non-enveloped, double-stranded DNA virus, with a genome of approximately 8000 nucleotides. There are more than 118 different types of HPV, and approximately 40 different HPVs that can infect the human anal-genital and oral cavity mucosa. Persistent infection with HPV is the principal cause of cervical cancer and its precursor cervical intraepithelial neoplasia (CIN). The presence of HPV has been implicated in greater than 99% of cervical cancers, worldwide. However, only a subset of approximately 14 of these types is considered high-risk for the development of cervical cancer and its precursor lesions.

Specimen Requirements

ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls 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. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

B: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Anal ThinPrep (using a Dacron/Floq Swab or Cytobrush)

Note expiry date on sample collection vial. Do not use expired vials.
Insert the swab or cytobrush into the anal cavity and rotate for approximately 10-30 seconds.
Rinse the brush into the vial by rotating in the PreservCyt solution at least 10 times while pushing against the vial wall. Do not discard the collection device, carefully cut and leave it in the vial.
If the swab or cytobrush is grossly contaminated with feces, discard and repeat the collection.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

D: Oral ThinPrep (using a Dacron/Floq Swab or Cytobrush)

Note expiry date on sample collection vial. Do not use expired vials.
Insert the swab or cytobrush into the oral cavity and rotate for approximately 10-30 seconds.
Rinse the brush into the vial by rotating in the PreservCyt solution at least 10 times while pushing against the vial wall. Do not discard the collection device, cut and leave it in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

Not required.

Unacceptable Specimen Conditions

Specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous less than 1mL of ThinPrep volume after the Pap test. Anal specimen grossly contaminated with feces.

Insurance Pre-Authorization Required

Not required.

Human Papilloma Virus RNA Detection with genotyping of 16 and 18/45

Methodology

Transcription Mediated Amplification (TMA) and Hybridization Protection Assay (HPA).

Turn Around Time (TAT)

5 days

Test Description

The Aptima HPV high risk assay is an in vitro nucleic acid amplification test for the qualitative detection of E6/E7 viral messenger RNA (mRNA) from 14 high-risk types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) of HPV in cervical specimens. The Aptima HPV 16 18/45 genotype assay can differentiate HPV 16 from HPV 18 and 45, but does not differentiate between HPV 18 and HPV 45.

Clinical Significance

The Human Papilloma Virus (HPV) is a small, non-enveloped, double-stranded DNA virus, with a genome of approximately 8000 nucleotides. There are more than 118 different types of HPV, and approximately 40 different HPVs that can infect the human anal-genital and oral cavity mucosa. Persistent infection with HPV is the principal cause of cervical cancer and its precursor cervical intraepithelial neoplasia (CIN). The presence of HPV has been implicated in greater than 99% of cervical cancers, worldwide. However, only a subset of approximately 14 of these types is considered high-risk for the development of cervical cancer and its precursor lesions.

Specimen Requirements

ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls 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. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

B: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

Not required.

Unacceptable Specimen Conditions

Specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous. Less than 1mL of ThinPrep volume after the Pap test.

Insurance Pre-Authorization Required

Not required.

Trichomonas Vaginalis

Methodology

Transcription Mediated Amplification (TMA) and Hybridization Protection Assay (HPA)

Turn Around Time (TAT)

5 days

Test Description

The APTIMA Trichomonas vaginalis Assay is an automated, target amplification nucleic acid probe test that utilizes target capture for the in vitro qualitative detection of ribosomal RNA (rRNA) of Trichomonas vaginalis (TV) in urogenital specimens.

Clinical Significance

Trichomonas vaginalis (TV) is the most common curable sexually transmitted disease (STD) agent in the United States, with an estimated 7.4 million new cases occurring annually. Infections in women cause vaginitis, urethritis, and cervicitis. Discharge and small hemorrhagic lesions may be present in the genitourinary tract. Complications can include premature labor, low-birth-weight offspring, premature rupture of membranes, and post-abortion or post- hysterectomy infection. An association with pelvic inflammatory disease, tubal infertility, and cervical cancer with previous episodes of trichomoniasis has been reported. Symptomatic women with trichomoniasis usually complain of vaginal discharge, vulvovaginal soreness, and/or irritation. Dysuria is also common. However, it has been estimated that 10 to 50% of T. vaginalis infections in women are asymptomatic, and in men the proportion may even be higher.

Specimen Requirements

Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Vaginal swab – Clinician collection (using Aptima Unisex Swab Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Collect: Partially peel open the swab package and remove the swab. Remove the blue- shaft specimen collection swab. Do not touch the soft tip or lay the swab down. If you touch the soft tip, use a new APTIMA Combo 2 Unisex Swab Collection Kit.
Carefully insert the blue-shaft swab into the vagina about 2 inches (5 cm) past the introitus and gently rotate the swab for 10 to 30 seconds.
Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab and then withdraw the swab without touching the skin.
Align: Remove the cap from the Aptima Unisex Swab Media Tube and immediately place the swab into the transport tube so that the score line is at the top of the tube.
Break: Carefully break the swab shaft at the score line against the side of the tube.
Close: Tightly recap the Aptima Swab. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 60 days of collection.

B: Endocervical swab – Clinician collection (using Aptima Unisex Swab Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Remove excess mucus from the cervical ostium and surrounding mucosa using the cleaning swab (white-shaft swab in the package with red printing). Discard this swab. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: Insert the specimen collection swab (blue-shaft swab in the package with the green printing) into the endocervical canal. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling.
Withdraw the swab carefully; avoid any contact with the vaginal mucosa.
Align: Remove the cap from the Aptima Unisex Swab Media Tube and immediately place the swab into the transport tube so that the score line is at the top of the tube.
Break: Carefully break the swab shaft at the score line against the side of the tube.
Close: Tightly recap the Aptima Swab. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 60 days of collection.

C: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls 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. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 3 months of collection.

D: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 3 months of collection.

Patient Preparation

Not required.

Unacceptable Specimen Conditions

Specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

Herpes Simplex 1&2

Methodology

RT-PCR on Roche Cobas 4800 System

Equipment/Instrument

Roche Cobas 4800 System

Turn Around Time TAT

5 days

Test Description

The cobas® HSV 1 and 2 Test is an automated, qualitative in vitro diagnostic test, that utilizes real-time polymerase chain reaction (PCR), for the direct detection and differentiation of Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) DNA in clinician-collected, external anogenital lesion specimens from symptomatic male and female patients. The cobas® HSV 1 and 2 Test is intended for use as an aid in diagnosis of anogenital HSV-1 and HSV-2 infections in symptomatic patients.

Clinical Significance

Genital herpes is a sexually transmitted disease (STD) caused by Herpes simplex virus (HSV-1 and HSV-2), ubiquitous double-stranded neurotropic DNA viruses of the Herpesviridae family. Following primary infection via secretions the virus persists lifelong. The virus may remain latent for a prolonged time or cause recurrent episodes of reactivated symptomatic disease; the number of recurrences tends to decrease over a period of years. Most genital herpes infections are caused by HSV-2. HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips. Transmission of genital herpes is commonly caused by individuals that are unaware of their infections, or those with asymptomatic infections. Pre- or perinatal transmission of HSV to the neonate may result in severe disease or even death.

Specimen Requirements

AnoGenital Lesion

Sample Collection, Storage and Transport

Swab
See OB/GYN Specimen Collection Media Information Below. Storage and Transport at Room Temperature.

Patient Preparation

Not required.

RPR for Syphilis

Methodology

Floculation

Turn Around Time (TAT)

2 days

Test Description

The ASI RPR Test is a qualitative and semi quantitative nontreponemal flocculation test to be used for the macroscopic detection of regain antibodies in human serum as a screening test in syphilis serology. The micro particulate carbon RPR antigen enhances the visual discrimination between reactive and nonreactive results. The reagin-type antibody binds with the antigen that is composed of a complex of cardiolipin, lecithin and cholesterol particles with activated charcoal.

Clinical Significance

Treponema pallidum subspecies pallidum is the etiological agent of venereal syphilis, a sexually transmitted infection (STI). Treponema pallidum induces the production of anti-nontreponemal antibodies (regain) in human infection. If left untreated, syphilis can result in multisystem involvement with significant morbidity. Of note, mothers infected with syphilis can pass the infection to their children in utero (congenital syphilis).

Specimen Requirements

Serum (Red Top Blood Collection Tube)

Sample Collection, Storage and Transport

Serum

Note expiry date on sample collection tube. Do not use expired tubes.
Perform a routine venipuncture procedure for blood collection.
Serum specimens should be separate from blood clot by centrifugation at 2,500rpm for 5 minutes within the 72hours of collection and stored refrigerated at 2-8°C from up to 5 days, or frozen until assayed.

Special Patient Preparation

Not Required.

Unacceptable Specimen Conditions

Strongly Hemolyzed specimens. Strongly lipemic specimens. Expired collection tube.

Insurance Pre-Authorization Required

Not Required.

PAP Test

Methodology

Conventional Smear

Equipment/Instrument

Leica Autostainer XL

Turn Around Time TAT

4-5 days

Test Description

The Pap test has proven to be extremely cost-effective cancer screening tool. By detecting cervical abnormalities that can be treated before they develop into invasive cancer, Pap smear has correlated with remarkable reduction in the morbidity and mortality of this disease. Pap test can be useful identifying inflammatory conditions and specific infectious agents.

Clinical Significance

The sensitivity of the conventional Pap smear may be as low as 50%. Limitations of Pap test include problems with sampling , interpretation and clinical follow-up.

Specimen Requirements

A Pap test should be performed at least 2 weeks after the 1st day of the last menstrual period (LMP). Use of a lubricant gel applied to facilitate insertion of the speculum should be avoided if possible. However, many clinicians use water-soluble gel lubricants. The frosted end of the glass slide should be labeled with patient’s name and the requisition form should be completed. Lab requisitions for Pap test should include the last menstrual period as well of any history of a prior abnormal Pap, treatment or biopsy.

Sample Collection, Storage and Transport

The slide is placed on the cardboard holder and then placed in a biohazard bag with the requisition form. Slide. Storage and Transpor at Room Temperature.

Patient Preparation

Woman should ideally refrain from intercourse, douching, using tampons, using intravaginal medication or contraceptives for at least 48 hours before Pap test.

ThinPrep PAP Test

Methodology

Liquid based preparation

Equipment/Instrument

TP Processor 2000

Turn Around Time TAT

4-5 days

Test Description

Liquid based technology has revolutionized the Pap test and now accounts for as much as 80% of all collection methods. The benefits includes a better slide quality by reducing obscuring blood and inflammatory exudate. Also increase the sensitivity in detection of squamous lesions.

Clinical Significance

The sensitivity in detection of SIL increase as high as 95% using liquid based cytology. The advantage of LBC is that specimens can undergo automated screening and the residual vial material can be used to make additional slides and perform ancillary testing including HPV, Chlamydia/Gonorrhea and Trichomonas.

Specimen Requirements

Collect the ThinPrep Pap sample with either a broom-type device or a plastic spatula/endocervical brush combination. The sampling device is rinsed in a methanol based preservative solution (PresevCyt) for transport to the laboratory.

Sample Collection, Storage and Transport

Thin Prep Ectocervix sample with a plastic spatula:

Insert the plastic spatula and rotate it 360 degrees around the entire ectocervix while maintaining tight contact with ectocervical surface.
Rinse the spatula into the vial by swirling vigorously 10 times.
Tighten the cap, label the vial with two patients’s identifiers and place it with a laboratory requisition in a specimen bag for transport.

Endocervix sample with brush device:

Insert the brush into the cervix and slowly rotate ¼ or ½ turn in one direction. DO NOT OVER-ROTATE.
Rinse the brush into the vial by rotating in the solution 10 times while pushing against the vial wall.
Swirl the brush vigorously to further release material.
Tighten the cap, label the vial with two identifiers and place it with a laboratory requisition in a specimen bag for transport.

Store PreservCyt Solution with cytologic sample intended for ThinPrep Pap testing between 15˚C (59˚F) and 30˚C (86˚F) for up to 6 weeks.

Patient Preparation

A Pap test should be avoided during menstrual bleeding. Blood may obscure important findings and result in unsatisfactory preparations.

Breast FNA

Methodology

Cytocentrifuge
Liquid based preparation
Cell block

Equipment/Instrument

TP Processor 2000

Turn Around Time TAT

2-3 days

Test Description

Fine needle aspiration can be used to evaluate palpable and nonpalpable, mammographically evident breast lesions. Breast FNA can occasionally be therapeutic as well as diagnostic in cases of abscess and benign breast cyst.

Clinical Significance

The advantages of breast FNA include the fact that is a rapid, simple cost effective procedure with rare complications. Breast FNA also has high diagnostic accuracy and is useful in the management of a palpable breast mass. Sensitivity for malignancy ranges from 65% to 98%. Obtaining a good clinical history prior to breast FNA is essential to determine if there is a family or personal history of malignancy. A strong family history of breast carcinoma requires adequate sampling and material for cell block for potential ancillary testing.

Specimen Requirements

Collect the aspiration in a sterile container, PreservCyt vial or in directly smear slide. Immediately fix the slide in 95% alcohol . Identify the the container and slides with patient’s name, location site and collection date.

Sample Collection, Storage and Transport

Place the slide on a carboard holder. Store PreservCyt solution with non-gynecological sample between 4˚C (39˚F) and 37˚C (98˚F) for up to 3 weeks.

Nipple Discharge

Methodology

Cytocentrifuge
Liquid based preparation
Cell block

Equipment/Instrument

TP Processor 2000

Turn Around Time TAT

2-3 days

Test Description

Nipple discharge cytology is a simple, noninvasive method that complements patient assessment. The most common cause of nipple discharge is hormonal influences. However, pathologic conditions may lead to nipple discharge in the absence of pregnancy and lactation.

Clinical Significance

Pathologic nipple discharge is associated with papilloma; fibrocystic disease (most common) and rarely by carcinoma. The sensitivity of nipple discharge cytology ranges from 41% to 60%.

Specimen Requirements

Nipple discharge specimens are prepared by gently massaging the breast in the direction of the nipple. A glass slide is then touched by secreted drops; the discharge need not be smeared unless it is abundant.

Sample Collection, Storage and Transport

The slides are fixed by spray fixation or by immersion in 95% ethyl alcohol. Label the end frosted with patient’s name, date of birth, location site and collection date. Place the slide on a cardboard holder for transportation

RPR for Syphilis

Methodology

Floculation

Turn Around Time (TAT)

2 days

Test Description

The ASI RPR Test is a qualitative and semi quantitative nontreponemal flocculation test to be used for the macroscopic detection of regain antibodies in human serum as a screening test in syphilis serology. The micro particulate carbon RPR antigen enhances the visual discrimination between reactive and nonreactive results. The reagin-type antibody binds with the antigen that is composed of a complex of cardiolipin, lecithin and cholesterol particles with activated charcoal.

Clinical Significance

Treponema pallidum subspecies pallidum is the etiological agent of venereal syphilis, a sexually transmitted infection (STI). Treponema pallidum induces the production of anti-nontreponemal antibodies (regain) in human infection. If left untreated, syphilis can result in multisystem involvement with significant morbidity. Of note, mothers infected with syphilis can pass the infection to their children in utero (congenital syphilis).

Specimen Requirements

Serum (Red Top Blood Collection Tube)

Sample Collection, Storage and Transport

Serum

Note expiry date on sample collection tube. Do not use expired tubes.
Perform a routine venipuncture procedure for blood collection.
Serum specimens should be separate from blood clot by centrifugation at 2,500rpm for 5 minutes within the 72hours of collection and stored refrigerated at 2-8°C from up to 5 days, or frozen until assayed.

Special Patient Preparation

Not Required.

Unacceptable Specimen Conditions

Strongly Hemolyzed specimens. Strongly lipemic specimens. Expired collection tube.

Insurance Pre-Authorization Required

Not Required.

Anal Cytology

Methodology

Liquid based preparation

Equipment/Instrument

TP Processor 2000

Turn Around Time TAT

2-3 days

Test Description

Anal cytology is used as a screening test for ASIL. An essential component of anal examination is the digital anorectal exam (DARE). This is the primary anal cancer screening test. When screening is directed to the populations at high risk for anal cancer, cytologic abnormalities are common.

Clinical Significance

The most important risk factor for anal neoplasia is infection by human papilloma virus (HPV). Other risk factors include receptive anal intercourse, number of life-time sexual partners, history of cervical, vaginal and or vulvar cancer, HIV infection and smoking. Sensitivity of anal cytology for HSIL were comparable to that of Pap test ranging from 69% to 93%.

Specimen Requirements

Anal cytology specimens should be sample the entire anal canal including anorectal transformation zone. The sample is collected with the patient in the lateral recumbent or dorsal lithotomy position. A Dacron swab moistened with tap water or cytobrush is inserted about 5 to 6 cm into anal canal. The swab is rotated with firm lateral pressure and slowly withdrawn. Rinse the Dacron swab or cytobrush in to PreservCyt vial.

Sample Collection, Storage and Transport

Store PreservCyt solution with non-gynecological sample between 4˚C (39˚F) and 37˚C (98˚F) for up to 3 weeks.

Oral Cytology

Methodology

Liquid based preparation

Equipment/Instrument

TP Processor 2000

Turn Around Time TAT

2-3 days

Test Description

Oral Cytology is an effective tool in screening for oral cancer, pre cancer and other specific viral diseases. Oral brush cytology is a simple and rapid, non-aggressive and relatively painless collection method.

Clinical Significance

Oral cytology has potential application for screening programs and for the surveillance of patients with confirmed cancerous and precancerous lesions.

Specimen Requirements

Oral Cytology can be obtained by brushing visible lesions, border of the tongue and oral mucosa, rotating the brush 10 times. Then rinse cytobrush in to PreservCyt vial.

Sample Collection, Storage and Transport

Store PreservCyt solution with non-gynecological sample between 4˚C (39˚F) and 37˚C (98˚F) for up to 3 weeks.

Fine Needle Aspiration (FNA)

Methodology

Smears
Liquid based preparation
Cell Block

Equipment/Instrument

TP Processor 2000
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

Fine needle aspiration is a non-invasive diagnostic procedure that can be performed in different tissue; the most common targets are breast, salivary gland, thyroid and lymph nodes. FNA can be performed by palpation or with the use of image-guidance.

Clinical Significance

FNA provides a minimally invasive, quick, accurate, cost-effective way to obtain diagnostic material that can provide clinical answers to guide treatment decisions. Most complications associated with FNA includes: minor pain, bleeding and bruising. A hematoma develops occasionally. The reported sensitivity of this procedure for salivary gland neoplasm is greater than 90% and for thyroid 83 – 99%. Use of ancillary techniques including immunocytochemistry, flow cytometry and molecular test to diagnose malignancy increase sensitivity and accuracy of FNA.

Specimen Requirements

Label the slides with patient’s name, date of birth and location of the mass. Smears can be prepared by spreading material into a thin, even layer on a glass slide. Also the aspirated material can be rinsed into a liquid based cytology solution to minimize obscuring blood or debris.

Sample Collection, Storage and Transport

The slide should be immediately placed in 95% alcohol or spray fixed to avoid air-drying artifact. Place the slide on a plastic holder for transportation. Store PreservCyt solution with non-gynecological sample between 4˚C (39˚F) and 37˚C (98˚F) for up to 3 weeks.

Patient Preparation

Patient under anticoagulant therapy cannot be evaluated until this treatment is temporarily discontinued. Order to discontinue any medication should be given by referring or primary care physician only.

Synovial Fluid

Methodology

Cytocentrifuge
Liquid based preparation

Equipment/Instrument

TP Processor 2000
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

Synovial fluid, which lubricates the joints, is secreted by synovium, a membrane lining the joint capsules, provided with a highly specialized epithelium. Under normal circumstances, the fluid forms a thinlayer moistening the surface of the joints. The volume of synovial fluid may increase after trauma or inflammation and can then be aspirated for cytologic analysis.

Clinical Significance

As in other body cavities, there is normally only a small amount of fluid in the joint space; increased fluid or an effusion, indicates a pathologic process. Microscopic examination of synovial fluid can detect infections, crystals and tumors, as well as suggest diseases such as lupus erythematosus.

Specimen Requirements

Synovial fluid should be anticoagulated (heparin or liquid EDTA) for cytologic examination to prevent clotting.

Sample Collection, Storage and Transport

The fluid should be examined fresh, preferably within 24 – 48 hours after collection.

Her2 on Breast Tissue

Methodology

Fluorescent In situ Hybridization
Liquid based preparation

Equipment/Instrument

Abbott Her2 DNA Probe Kit

Turn Around Time TAT

10 days

Test Description

In situ hybridization is a technique that allows the visualization of specific nucleic acid sequences within a cellular preparation. Specifically, DNA fluorescence in situ hybridization (FISH) involves the precise annealing of a single stranded, fluorescently-labeled DNA probe to complementary target sequences. The hybridization of the probe with the cellular DNA site is visible by direct detection using fluorescence microscopy.HER-2 DNA FISH detect amplification of the HER-2/neu gene via fluorescence in situ hybridization (FISH) in formalin-fixed, paraffin-embedded human breast cancer tissue specimens.

Clinical Significance

Results from the HER-2 FISH are intended for use as an adjunct to existing clinical and pathologic information currently used as prognostic. The HER-2 FISH assay is indicated as an aid in the assessment of breast cancer patients for whom HERCEPTIN® (trastuzumab) treatment is being considered.

Specimen Requirements

Breast tissue

Sample Collection, Storage and Transport

Fix tissue in 10% neutral buffered formalin iimmediately after collection to avoid tissue degradation.
Label the vial with the sample type and two patient’s identifiers.
Store and transport at room temperature in 24 hours after collection.
Formalin Fixed Parafin Embeded (FFPE) tissues are also acceptable.

Patient Preparation

Not Required.

Her2 on Gastric Tissue

Methodology

Fluorescent In situ Hybridization
Liquid based preparation

Equipment/Instrument

Abbott Her2 DNA Probe Kit

Turn Around Time TAT

10 days

Test Description

In situ hybridization is a technique that allows the visualization of specific nucleic acid sequences within a cellular preparation. Specifically, DNA fluorescence in situ hybridization (FISH) involves the precise annealing of a single stranded, fluorescently-labeled DNA probe to complementary target sequences. The hybridization of the probe with the cellular DNA site is visible by direct detection using fluorescence microscopy.HER-2 DNA FISH detect amplification of the HER-2/neu gene via fluorescence in situ hybridization (FISH) in formalin-fixed, paraffin-embedded human gastric cancer tissue specimens.

Clinical Significance

Results from the HER-2 FISH are intended for use as an adjunct to existing clinical and pathologic information currently used as prognostic. The HER-2 FISH assay is indicated as an aid in the assessment of gastric cancer patients for whom HERCEPTIN® (trastuzumab) treatment is being considered.

Specimen Requirements

Gastric tissue

Sample Collection, Storage and Transport

Fix tissue in 10% neutral buffered formalin immediately after collection to avoid tissue degradation.
Label the vial with the sample type and two patient’s identifiers.
Store and transport at room temperature in 24 hours after collection.
Formalin Fixed Parafin Embeded (FFPE) tissues are also acceptable.

Patient Preparation

Not Required.

UroVysion

Methodology

Fluorescent In-situ Hybridization (FISH)

Turn Around Time TAT

10 days

Test Description

The Abbott® UroVysion Bladder Cancer Kit is designed to detect aneuploidy for chromosomes 3, 7, 17, and the loss of the 9p21 locus via FISH in urine specimens from persons with hematuria suspected of having bladder cancer.

Clinical Significance

Results from the UroVysion Kit are intended for use, in conjunction with and not in lieu or current standard diagnostic procedures, as an aid for initial diagnosis of bladder carcinoma in patients with hematuria and subsequent monitoring for tumor recurrence in patients previously diagnosed with bladder cancer.

Specimen Requirements

Voided urine specimen with PreservCyt 2:1 (v:v). Minimum 33mL.

Sample Collection, Storage and Transport

To obtain the greatest yield of diagnostic material:

Collect at least 33mL of the second-morning, clean-catch voided urine specimen in Urine Cytology cup. The patient should not be urinated at least in two hour from the first urine.
Tighten the cap.
Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
Transport to the laboratory at room temperature within the first 24 hours or store at 2- 8°C for up to 72 hours days.

Special Patient Preparation

The patient should not be urinating at least in two hour from the first urine.

Unacceptable Specimen Conditions

Specimens in inappropriate fixative. Specimens submitted in expired reagents. Insufficient quantity urine. Urine specimens with more than 72 hours of collection. Low cellularity.

Insurance Pre-Authorization Required

Yes (CPT: 88120)

Cerebrospinal Fluid (CSF)

Methodology

Cytocentrifuge
Liquid based preparation

Equipment/Instrument

TP Processor 2000
Cytopro
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

Cerebrospinal fluid is an ultrafiltrate of plasma produced by the chroroid plexus that flows the ventricles to the subarachnoid space and is a reabsorbed through the arachnoid villi into venous sinuses.

Clinical Significance

CSF cytologic examination is not a screening test, but a crucial diagnostic test for evaluating a wide variety of treatable yet potentially fatal diseases and conditions affecting the CNS. Conditions that can be diagnosed by cytologic examination includes: Primary tumors of the CNS or metastatic cancer, Infectious disease (meningitis and encephalitis), Inflammatory disease and Hemorrhage. Other noncytologic tests can be done on CSF including cell counts, chemical analysis, immunologic and serologic testing, flow cytometry, molecular testing and microbiologic culture. The sensitivity of CSF cytology for detecting malignant cells is about 60%, but sensitivity depends on several factors. The sensitivity of a single cytologic examination is 54% but increases to 84% with a second sample.

Specimen Requirements

CSF specimens are most commonly obtained by passing a needle through the intervertebral space of the lumbar portion of the spinal column with the patient on his or her side (lumbar puncture). A minimum of 1 mL should be collected for cytologic evaluation, but 3 mL or more is preferable.

Sample Collection, Storage and Transport

CSF should be collected fresh and delivered to the laboratory as quickly as possible to prevent cellular degeneration. If specimen cannot be prepared immediately, it should be refrigerated at 4˚C. If a delay of more than 48 hours is anticipated, cytomorphology can be preserved by adding an equal volume of 50% ethanol or RPMI.

MSI Panel Molecular

Methodology

PCR by Reference Laboratory

Turn Around Time (TAT)

10 days

Test Description

Varies by Reference Laboratory

Clinical Significance

MSI analysis and/or MMR IHC may be considered for all new colorectal cancer diagnoses to detect patients at increased risk of carrying germline mutations associated with Lynch Syndrome (HNPCC). Testing is recommended for tumors of patients meeting the Bethesda Guidelines. Recently, Keytruda (pembrolizumab) is indicated for the treatment of adult and pediatric patients with unresectable or metastatic solid tumors that have been identified as having a biomarker referred to as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR). MSI is also detected in sporadic colorectal cancer and its presence may imply better prognosis.

Specimen Requirements

Tumor and additional patient sample from normal, non-tumor tissue is required for comparison testing in MSI Analysis. Specimens for normal tissue are: 5 mL peripheral blood in EDTA tube OR FFPE tissue slides or block containing only non-tumor tissue. Please label these as “normal tissue”. OR in cases where no alternative tissue is available, we can attempt to isolate non- tumor tissue from the tumor specimen submitted.

Sample Collection, Storage and Transport

1. Fix Tumor and Normal tissue in 10% neutral buffered formalin immediately after collection to avoid tissue degradation. Formalin Fixed Paraffin Embedded (FFPE) tissues are also acceptable. Specimens for normal tissue are: 5 mL peripheral blood in EDTA tube OR FFPE tissue slides or block containing only non-tumor tissue. Please label these as “normal tissue”.
2. Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
3. Store and transport at room temperature in 24 hours after collection.

Special Patient Preparation

None

Unacceptable Specimen Conditions

Specimens fixed/processed in alternative fixatives. Insufficient quantity of tumor tissue.

Insurance Pre-Authorization Required

Yes (CPT: 81301)

BRAF

Methodology

Real Time-PCR or Sequencing

Turn Around Time (TAT)

10 days

Test Description

The cobas® 4800 BRAF V600 Mutation Test is an in vitro diagnostic real-time PCR test intended for the qualitative detection of BRAF V600E mutation in DNA extracted from formalin-fixed, paraffin-embedded human colorectal tissue. Melanoma, Lung and other specimen types for BRAF by RT-PCR or Sequencing are sent to reference laboratory.

Clinical Significance

The tests is intended to be used as an aid in selecting patients whose tumors carry the BRAF V600E mutation for treatment with BRAF inhibitor therapy (ex. vemurafenib). Detection of BRAF V600 mutation in colorectal cancer provides information about patient’s prognosis, response to therapy and may be used as an aid in the diagnosis of Lynch Syndrome. Information obtained from BRAF mutation analysis is used for selection of melanoma patients for vemurafenib therapy and for determination of prognosis and predicting response to anti-EGFR therapy in colon cancer.

Specimen Requirements

Colon, Melanoma and Lung, Tumor Tissue

Sample Collection, Storage and Transport

Fix tissue in 10% neutral buffered formalin immediately after collection to avoid tissue degradation. Formalin Fixed Paraffin Embedded (FFPE) tissues are also acceptable.
Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
Store and transport at room temperature in 24 hours after collection.

Special Patient Preparation

None

Unacceptable Specimen Conditions

Specimens fixed/processed in alternative fixatives. Insufficient quantity of tumor tissue.

Insurance Pre-Authorization Required

Yes (CPT: 81210)

EGFR

Methodology

Real Time-PCR or Sequencing

Turn Around Time (TAT)

10 days

Test Description

The cobas® EGFR Mutation Test v2 is a real-time PCR test for the qualitative detection of defined mutations of the epidermal growth factor receptor (EGFR) gene in non-small cell lung cancer (NSCLC) patients. The cobas® EGFR Test is designed to detect the following mutations:

Exon 18: G719X (G719A, G719C, and G719S),
Exon 19: deletions and complex mutations (defined as the combination of a deletion and an insertion),
Exon 20: S768I, T790M, and insertions,
Exon 21: L858R and L861Q.

Types of specimens other than lung for EGFR by RT-PCR or Sequencing are sent to reference laboratory.

Clinical Significance

The test is indicated as a companion diagnostic to aid in selecting NSCLC patients for treatment with the targeted therapies in accordance with the approved therapeutic product labeling. EGFR mutation analysis is recommended in non-small cell lung carcinoma (NSCLC) to detect mutations associated with increased sensitivity to EGFR tyrosine kinase inhibitors.

Specimen Requirements

Lung, Tumor Tissue

Sample Collection, Storage and Transport

Fix tissue in 10% neutral buffered formalin immediately after collection to avoid tissue degradation. Formalin Fixed Paraffin Embedded (FFPE) tissues are also acceptable.
Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
Store and transport at room temperature in 24 hours after collection.

Special Patient Preparation

None

Unacceptable Specimen Conditions

Specimens fixed/processed in alternative fixatives. Insufficient quantity of tumor tissue.

Insurance Pre-Authorization Required

Yes (CPT: 81235)

KRAS

Methodology

Real Time-PCR or Sequencing

Turn Around Time (TAT)

10 days

Test Description

The cobas® KRAS Mutation Test is a real-time PCR test for the detection of somatic mutations in codons 12, 13 (exon 2) and 61 (exon 3) of the KRAS gene in DNA derived from formalin-fixed paraffin-embedded human colorectal cancer (CRC) tumor tissue. Types of specimens other than Colon for KRAS by RT-PCR or Sequencing are sent to reference laboratory.

Clinical Significance

The test is intended to be used as an aid in the identification of CRC patients who should not be treated with Erbitux® (cetuximab) or with Vectibix® (panitumumab) when KRAS Codon 12 or 13 mutations is detected. Safety and efficacy of Erbitux® (cetuximab) or Vectibix® (panitumumab) have not been established in patients whose tumors have Codon 61 mutation. KRAS mutation is also recommended in non-small cell lung cancer (NSCLC) to predict EGFR response and patient’s prognosis.

Specimen Requirements

Colon and Lung, Tumor Tissue

Sample Collection, Storage and Transport

Fix tissue in 10% neutral buffered formalin immediately after collection to avoid tissue degradation. Formalin Fixed Paraffin Embedded (FFPE) tissues are also acceptable.
Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
Store and transport at room temperature in 24 hours after collection.

Special Patient Preparation

None

Unacceptable Specimen Conditions

Specimens fixed/processed in alternative fixatives. Insufficient quantity of tumor tissue.

Insurance Pre-Authorization Required

Yes (CPT: 81275, 81276)

NRAS

Methodology

PCR by Reference Laboratory

Turn Around Time (TAT)

10 days

Test Description

Varies by Reference Laboratory

Clinical Significance

NRAS mutation is recommended in colorectal cancer to identify mutations associated to resistance to anti EGFR therapies. NRAS mutations have been described in a variety of cancers including 3-5% of colorectal carcinomas, 10-20% of melanomas and 10% of acute myeloid leukemia’s. Mutations leading to an amino acid substitution at positions 12, 13, 61 and 146 of NRAS are the most common in naturally occurring neoplasms.

Specimen Requirements

Colon, Tumor Tissue

Sample Collection, Storage and Transport

4. Fix tissue in 10% neutral buffered formalin immediately after collection to avoid tissue degradation. Formalin Fixed Paraffin Embedded (FFPE) tissues are also acceptable.
5. Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
6. Store and transport at room temperature in 24 hours after collection.

Special Patient Preparation

None

Unacceptable Specimen Conditions

Specimens fixed/processed in alternative fixatives. Insufficient quantity of tumor tissue.

Insurance Pre-Authorization Required

Yes (CPT: 81311)

CD4 Count for HIV Patients

Methodology

Flow Cytometry

Turn Around Time TAT

1-2 days

Reference

Immunophenotyping of T-lymphocytes with monoclonal antibodies against CD3, CD4 and CD8 molecules expressed in the surface of cells. Specific cell staining is accomplished by incubating whole blood with the monoclonal antibody reagent

Clinical Significance

Identification of abnormal levels of CD4+ immunodeficiency, and corresponding CD4+/CD8+ ratios, might also aid in the diagnosis and/or prognosis of immunodeficiency disease. For example, infection with human immunodeficiency virus (HIV), the etiologic agent of acquired immunodeficiency syndrome (AIDS), results in profound immunosuppression due predominantly to a selective depletion of the CD4+ lymphocytes that express the receptor for the virus. Progressive clinical and immunologic deterioration generally correlates with a decreasing CD4+ lymphocyte count.

Specimen Requirements

Peripheral Blood

Sample Collection, Storage and Transport

Peripheral Blood in EDTA. Transport at room temperature. Sample must be processed in 24 hours from the collection time.

Leukemia/Lymphoma Panel

Methodology

Flow Cytometry

Equipment/Instrument

Beckman Coulter FC-500

Turn Around Time TAT

1-3 days

Test Description

Immunophenotyping of White Blood Cells (WBC) from specimens with known or suspected hematopoietic neoplasms or other hematological disorders.

Clinical Significance

Hematopoietic neoplasms and other hematological disorders may be identified.

Specimen Requirements

Bone Marrow, Peripheral Blood, Cerebrospinal Fluid, Fresh Tissue, others.

Sample Collection, Storage and Transport

Bone Marrow and Peripheral Blood must be collected in Heparin. Cerebrospinal fluid and fresh tissue must be collected in saline (i.e. PBS 1x) or RPMI solution. Sample must be transported at room temperature.

Methicillin-Resistant Staphylococcus Aureus (MRSA) by DNA Detection

Methodology

Real Time PCR

Turn Around Time (TAT)

3 days

Test Description

The cobas® MRSA/SA Test is a qualitative in vitro diagnostic real-time PCR assay, for the direct detection of methicillin-resistant Staphylococcus aureus (MRSA) and S. aureus (SA) DNA from nasal swabs to aid in the prevention and control of MRSA and SA infections in healthcare settings.

Clinical Significance

Staphylococcus Aureus (SA) is an opportunistic pathogen carried as a commensal organism on the skin and nares of approximately 30% of the normal population. It has the potential to cause a broad spectrum of diseases. SA can rapidly adapt to the selective pressure of antibiotics, which has resulted in the emergence and spread of Methicillin Resistant Staphylococcus aureus (MRSA) strains.SA and MRSA strains are a major source of healthcare-acquired infections and have been responsible for bacterial outbreaks in healthcare settings worldwide for many years. SA and MRSA infections are a tremendous burden for healthcare systems, for single hospitals, and are associated with significant healthcare costs. Guidelines and recommendations as well as hospital standard procedures recommend active screening and isolation and/or decolonization of patients as measures to control the spread of MRSA and SA.

Specimen Requirements

Nasal swab

Sample Collection, Storage and Transport

Nasal Swab (using the MSwab Kit)

Note expiry date on sample collection tube. Do not use expired tubes.
Use the flocked swab provided in the MSwab collection kit.
Swab may be used either dry or pre-moistened with two drops of sterile physiological saline.
Carefully insert the swab into the patient’s nostril (swab tip should be inserted up to 2.5 cm (1 inch) from the edge of the nares).
Roll the swab along the mucosa inside the nostril 3 times. Repeat in second nostril with the same swab.
Replace the swab in its transport tube.
Leverage the swab shaft against the edge of the tube to break at pre-scored point.
Tightly recap the MSwab tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 4 days of collection.

Special Patient Preparation

Not Required.

Unacceptable Specimen Conditions

Specimen contains excess of blood (has a dark red or brown color), Expired collection vial, specimens contains excess of mucous, swab specimens with more than one Flock swab or without Flock swab inside.

Insurance Pre-Authorization Required

Not Required.

Herpes Simplex 1&2

Methodology

Real Time-PCR

Turn Around Time (TAT)

5 days

Test Description

The cobas® HSV 1 and 2 Test is an automated, in vitro nucleic acid amplification test for the qualitative direct detection and differentiation of Herpes simplex virus 1 (HSV-1) and 2 (HSV-2) DNA in clinician-collected, external anogenital lesion specimens from symptomatic male and female patients.

Clinical Significance

Genital herpes is a sexually transmitted disease (STD) caused by Herpes simplex virus (HSV-1 and HSV-2), ubiquitous double-stranded neurotropic DNA viruses of the Herpesviridae family. Following primary infection via secretions the virus persists lifelong. The virus may remain latent for a prolonged time or cause recurrent episodes of reactivated symptomatic disease; the number of recurrences tends to decrease over a period of years. Most genital herpes infections are caused by HSV-2. HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips. Transmission of genital herpes is commonly caused by individuals that are unaware of their infections, or those with asymptomatic infections. Pre- or perinatal transmission of HSV to the neonate may result in severe disease or even death.

Specimen Requirements

Anogenital Lesion Swab, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Anogenital Lesion with vesicles present (clear fluid-filled blister)

Note expiry date on sample collection vial. Do not use expired vials.
Wash/wipe the surface of the lesion with sterile saline.
Carefully uncap (disrupt) the vesicle with a FLOQSwab (preferred), needle or scalpel and collect the fluid with the FLOQSwab.
With the same FLOQSwab, vigorously rub the base of the vesicle to collect cells at the base of the lesion.
Transfer the swab to its MSwab or Universal transport tube. Leverage the swab shaft against the edge of the tube to break at pre-scored point.
Close the cap firmly while ensuring that the upper end of the swab shaft is in the center of the cap.
Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 4 days of collection.

B: Anogenital Lesion with vesicles absent (ruptured and or weeping vesicle)

Note expiry date on sample collection vial. Do not use expired vials.
Using a dry FLOQSwab or one pre-moistened with two drops of sterile physiological saline, collect cells by vigorously rubbing the base of the lesion.
Transfer swab to the MSwab or Universal transport tube. Leverage the swab shaft against the edge of the tube to break at pre-scored point.
Close the cap firmly while ensuring that the upper end of the swab shaft is in the center of the center cap.
Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 4 days of collection.

C: Anogenital Lesion with vesicles absent (crusted ulcer)

Note expiry date on sample collection vial. Do not use expired vials.
Gently remove crust using a FLOQSwab pre-moistened with sterile saline.
Collect specimen by vigorously rubbing the base of the lesion.
Alternatively, gently abrade the lesion with a sterile scalpel or needle until serous fluid emerges (avoid bleeding) and collect the sample with a pre-moistened FLOQSwab by vigorously rubbing the base of the of the vesicle.
Transfer swab sample to MSwab or Universal transport tube. Leverage the swab shaft against the edge of the tube to break at pre-scored point.
Close the cap firmly while ensuring that the upper end of the swab shaft is in the center of the cap.
Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 4 days of collection.

Special Patient Preparation

For optimal results, specimens should be collected in the acute stage of the disease whenever possible, preferably within 3 days and less than 7 days after onset of illness (eruption of lesions).

Unacceptable Specimen Conditions

Specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens without Flock swab inside, specimens collected by the patient.

Insurance Pre-Authorization Required

Not required.

RPR for Syphilis

Methodology

Floculation

Turn Around Time (TAT)

2 days

Test Description

The ASI RPR Test is a qualitative and semi quantitative nontreponemal flocculation test to be used for the macroscopic detection of regain antibodies in human serum as a screening test in syphilis serology. The micro particulate carbon RPR antigen enhances the visual discrimination between reactive and nonreactive results. The reagin-type antibody binds with the antigen that is composed of a complex of cardiolipin, lecithin and cholesterol particles with activated charcoal.

Clinical Significance

Treponema pallidum subspecies pallidum is the etiological agent of venereal syphilis, a sexually transmitted infection (STI). Treponema pallidum induces the production of anti-nontreponemal antibodies (regain) in human infection. If left untreated, syphilis can result in multisystem involvement with significant morbidity. Of note, mothers infected with syphilis can pass the infection to their children in utero (congenital syphilis).

Specimen Requirements

Serum (Red Top Blood Collection Tube)

Sample Collection, Storage and Transport

Serum

Note expiry date on sample collection tube. Do not use expired tubes.
Perform a routine venipuncture procedure for blood collection.
Serum specimens should be separate from blood clot by centrifugation at 2,500rpm for 5 minutes within the 72hours of collection and stored refrigerated at 2-8°C from up to 5 days, or frozen until assayed.

Special Patient Preparation

Not Required.

Unacceptable Specimen Conditions

Strongly Hemolyzed specimens. Strongly lipemic specimens. Expired collection tube.

Insurance Pre-Authorization Required

Not Required.

Effusions

Methodology

Cytocentrifuge
Liquid based preparation
Cell block

Equipment/Instrument

Cytopro
TP Processor 2000
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

An effusion is the accumulation of fluid in a serous body cavity (pleural, peritoneal and pericardial space). The primary purpose of cytology examination of serous fluid specimen is to detect malignancy. However. it is also possible to diagnose a variety of benign and infectious entities.

Clinical Significance

Diagnostic accuracy of effusion cytology depends on the volume of the liquid specimen examined (minimum of 20 – 50 mL is required), the type preparation and staining, the experience / training of the examiner, and the number of specimens examined. The sensitivity of one specimen is 53%, and this increases to 67% with 2 specimens and 73% with 3 specimens. Cell block preparation increases the sensitivity of detecting malignancy by 5 -10%. It is also useful for performing ancillary testing, if needed.

Specimen Requirements

Serous fluid should be collected in a clean container without fixative, and sent directly to the laboratory. If the specimen cannot be directly sent, it can be refrigerated at 4˚C or adding a fixative, (50% alcohol or Cytolyt Solution).

Sample Collection, Storage and Transport

Large quantities, ususally received in plastic bags shold be keep it refrigerated at 4˚C until transport. Label all containers with complete patient name, date of birth, collection date and specimen type.

Bronchial Brushings and Washings

Methodology

Cytocentrifuge
Liquid based preparation

Equipment/Instrument

Cytopro
TP Processor 2000
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

These specimens are from the lower respiratory tract and obtained using bronchoscopy. Brushings will usually be performed if there is a lesion that can be visualized on bronchoscopy, whereas a washing is typically done if there is no discrete endobronchial lesion seen.

Clinical Significance

For diagnosis of endobronchial lesion or masses. The diagnostic accuracy of bronchial washing / brushing cytology is comparable to that of bronchial biopsy. Accuracy improves when clinical history is provided with the specimen. The diagnostic yield also improves when several different sampling methods are used in concert.

Specimen Requirements

Bronchial secretions can be aspirated directly from the lower respiratory tract through the bronchoscope, but an alternative (and more common)method is to wash the mucosa by instilling 3 to 10 mL of saline and suctioning the washings. Fiberoptic bronchoscopy allows direct visualization of the tracheobronchial tree. A brush is applied to the surface of an endobronchial lesion to collect the cells.

Sample Collection, Storage and Transport

Bronchial washings should be collected in sterile container and fixed in 95% alcohol or Cytolyt solution. For bronchial brushings the entrapped cells are either smeared onto a glass slide or rinsed in a collection medium for thinlayer or in saline solution. If smeras are made immediate fixation into 95% alcohol or by spray is essential to preserve morphology details.

Bronchoalveolar Lavage

Methodology

Cytocentrifuge
Liquid based preparation

Equipment/Instrument

Cytopro
TP Processor 2000
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

BAL specimens are obtained by infusion and reaspiration of sterile saline into distal areas of the lung.

Clinical Significance

BAL is particularly useful for the diagnosis of opportunistic infections in immunocompromised patients. Sensitivity: 82% (comparable to transbronchial biopsy sensitivity of 86%), when done with biopsy, the sensitivity increases to 98%. BAL can occasionally be used in the diagnosis of malignancy. Sensitivity: 35 – 70% (higher for multifocal tumors like bronchoalvelar carcinoma. BAL can be done as a part of therapy for diseases like protein alveolar proteinosis, cystic fibrosis, pulmonary alveolar microlithiasis and asthma.

Specimen Requirements

With BAL, the bronchoscope is wedged into position as far as it will go in order to sample distal airways, which is flushed with sterile saline.

Sample Collection, Storage and Transport

BAL should be collected in sterile container and fixed in 95% alcohol or Cytolyt solution. Label the container with patient name, date of birth, collection date and specimen type.

Urine Cytology

Methodology

Cytology

Equipment/Instrument

TP Processor 2000
Cytopro
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

Urine cytology is a simple, inexpensive and effective tool in the detection and follow-up of high grade primary and secondary malignancies involving the urinary bladder.

Clinical Significance

The most common indication for urinary cytology is hematuria. Another indication is surveillance for recurrent Urothelial Carcinoma, because patients with a previously diagnosed and treated urothelial cancer are at risk for recurrence.

Specimen Requirements

Urine (Second collection of the day).

Sample Collection, Storage and Transport

ThinPrep (Preserv Cyt) Storage and Transport at Room Temperature.

Patient Preparation

Collect second urine of the morning and the patient should not be urinate at least in two hour from the first urine.

Urine Cytology X 3

Methodology

Cytocentrifuge
Liquid based preparation

Equipment/Instrument

TP Processor 2000
Cytopro
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

Urine cytology is a simple, inexpensive and effective tool in the detection and follow-up of high grade primary and secondary malignancies involving the urinary bladder. Urine cytology is also valuable in the detection of carcinoma insitu (CIS), where cystoscopy may be negative. It is also useful to follow-up recurrence of urothelial carcinoma (low and high grade), including screening for upper urinary tract lesions in patients status post cystectomy.

Clinical Significance

The most common indication for urinary cytology is hematuria. Another indication is surveillance for recurrent Urothelial Carcinoma, because patients with a previously diagnosed and treated urothelial cancer are at risk for recurrence. Several variables affect the sensitivity of urine cytology. First, sensitivity is higher (37% to 89%) when suspicious diagnoses are included with positive diagnoses. Second, the sensitivity increases when more than one specimen is examined. For this reason, it has been recommended at least three specimens per patient be examined. Third, the sensitivity of urine cytology is highly dependent on the grade of the bladder tumor. Ancillary techniques such as FISH method may more sensitive than cytology.

Specimen Requirements

Three samples of urine are to be collected on 3 consecutive days. Second voided urine provide better preserved cells. First morning voided urine should be avoided because cells are mostly degenerated. The minimum amount of urine necessary to ensure adequate cellularity may be as high 25 to 100 mL.

Sample Collection, Storage and Transport

Collect the urine in container with PreservCyt solution to preserve cells. Store PreservCyt solution with non-gynecological sample between 4˚C (39˚F) and 37˚C (98˚F) for up to 3 weeks.

Patient Preparation

Collect second urine of the morning and the patient should not be urinate at least in two hour from the first urine. Repeat the process during three consecutive days.

UroVysion

Methodology

Fluorescent In-situ Hybridization (FISH)

Turn Around Time (TAT)

10 days

Test Description

The Abbott® UroVysion Bladder Cancer Kit is designed to detect aneuploidy for chromosomes 3, 7, 17, and the loss of the 9p21 locus via FISH in urine specimens from persons with hematuria suspected of having bladder cancer.

Clinical Significance

Results from the UroVysion Kit are intended for use, in conjunction with and not in lieu or current standard diagnostic procedures, as an aid for initial diagnosis of bladder carcinoma in patients with hematuria and subsequent monitoring for tumor recurrence in patients previously diagnosed with bladder cancer.

Specimen Requirements

Voided urine specimen with PreservCyt 2:1 (v:v). Minimum 33mL.

Sample Collection, Storage and Transport

To obtain the greatest yield of diagnostic material:

Collect at least 33mL of the second-morning, clean-catch voided urine specimen in Urine Cytology cup. The patient should not be urinated at least in two hour from the first urine.
Tighten the cap.
Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
Transport to the laboratory at room temperature within the first 24 hours or store at 2- 8°C for up to 72 hours days.

Special Patient Preparation

The patient should not be urinating at least in two hour from the first urine.

Unacceptable Specimen Conditions

Specimens in inappropriate fixative. Specimens submitted in expired reagents. Insufficient quantity urine. Urine specimens with more than 72 hours of collection. Low cellularity.

Insurance Pre-Authorization Required

Yes (CPT: 88120)

Stone Analysis • Calculi, Urinary with Photograph

Methodology

Optical microscopy

Equipment/Instrument

Reference Laboratory

Turn Around Time TAT

10 days

Test Description

Evaluate stone composition, metabolic factors affecting stone formation; work up nephrolithiasis.

Clinical Significance

The incidence of urinary tract calculi is common, with one person in 1000 requiring hospital care and treatment. A typical urinary calculus is composed of crystalline substances precipitated in the body. To ensure proper treatment and prevention of recurrences of urinary calculi, it is critical that crystalline constituents of the stone be identified.

Specimen Requirements

Calculi must be submitted completely dry.

Sample Collection, Storage and Transport

Room Temperature

Patient Preparation

Not Required.

Prostate Cancer Gene 3 (PCA3)

Methodology

In vitro Nucleic Acid Amplification Test

Equipment/Instrument

Reference Laboratory

Turn Around Time TAT

5-7 days

Test Description

The assay measures the concentration of Prostate Gene Cancer3 (PCA3) and Prostate Specific Antigen (PSA) RNA molecules and calculates the ratio of PSA RNA molecules (PCA3 Score) in post -digital exam (DRE)fist catch male urine specimens.

Clinical Significance

Prostate Cancer Gene 3 (PCA3) is strongly expressed in 95% of primary prostate cancer specimens. The PCA3 test is indicated for use in conjunction with other patient information to aid in the decision for repeat biopsy in men age 50 or older who have had one or more previous negative prostate biopsies and for whom a repeat biopsy would be recommended by an urologist based on current standard care. The PCA3 result provide a risk assessment of a positive biopsy. This assay should not be used for men with atypical small acinar proliferation (ASAP)on their most recent biopsy. Men with ASAP on their recent biopsy should be treated in accordance with current medical guidelines.

Specimen Requirements

Collect first catch (aprox. 20 – 30 ml of the initial stream) urine sample in an urine cup after DRE has been performed. Invert sample five times to resuspend the cells. Transfer 2.5 ml of urine (fill until the fluid level is between the black lines) into the Gen-Probe Progensa urine specimen transport tube using the disposable pipette provided. Recap the urine specimen transport tube tightly and invert five times to mix.

Sample Collection, Storage and Transport

Gen-Probe Urine Specimen Transport Tube. Refrigerated.
Important: Verify expiration date of the Gen Probe urine specimen transport tube before procedure. Samples taken in expired sample collection tubes are not accepted for processing. Samples should arrive at SPS in 48 hrs or less.

Patient Preparation

Before collection, patient must undergo an attentive digital rectal exam (three strokes per lobe).

Human Papillomavirus (HPV)

Methodology

Reak Time-PCR

Turn Around Time (TAT)

5 days

Test Description

The cobas® HPV high risk Test is an automated, in vitro nucleic acid amplification test for the qualitative detection of HPV in cervical, anal and oral specimens collected by a clinician. The test utilizes amplification of target DNA by the Polymerase Chain Reaction (PCR) and nucleic acid hybridization for the detection of 14 high-risk HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) in a single analysis and specifically identifies types HPV16 and HPV18.

Clinical Significance

The Human Papilloma Virus (HPV) is a small, non-enveloped, double-stranded DNA virus, with a genome of approximately 8000 nucleotides. There are more than 118 different types of HPV, and approximately 40 different HPVs that can infect the human anal-genital and oral cavity mucosa. Persistent infection with HPV is the principal cause of cervical cancer and its precursor cervical intraepithelial neoplasia (CIN). The presence of HPV has been implicated in greater than 99% of cervical cancers, worldwide. However, only a subset of approximately 14 of these types is considered high-risk for the development of cervical cancer and its precursor lesions.

Specimen Requirements

ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls 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. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

B: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirl the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Anal ThinPrep (using a Dacron/Floq Swab or Cytobrush)

Note expiry date on sample collection vial. Do not use expired vials.
Insert the swab or cytobrush into the anal cavity and rotate for approximately 10-30 seconds.
Rinse the brush into the vial by rotating in the PreservCyt solution at least 10 times while pushing against the vial wall. Do not discard the collection device, carefully cut and leave it in the vial.
If the swab or cytobrush is grossly contaminated with feces, discard and repeat the collection.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

D: Oral ThinPrep (using a Dacron/Floq Swab or Cytobrush)

Note expiry date on sample collection vial. Do not use expired vials.
Insert the swab or cytobrush into the oral cavity and rotate for approximately 10-30 seconds.
Rinse the brush into the vial by rotating in the PreservCyt solution at least 10 times while pushing against the vial wall. Do not discard the collection device, cut and leave it in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

Not required.

Unacceptable Specimen Conditions

Specimen contains excess of blood (has a dark red or brown color), Expired collection and transport vials, specimens contains excess of mucous. Less than 1mL of ThinPrep volume after the Pap test. Anal specimen grossly contaminated with feces.

Insurance Pre-Authorization Required

Not required.

Biopsy

Test Description

A biopsy is the medical removal of tissue from a living subject to determine the presence or extent of a disease. When the laboratory receives the biopsy sample, the tissue is processed and an extremely thin slice of tissue is removed from the sample and attached to a glass slide. Any remaining tissue is saved for use in later studies, if required. The slide with the tissue attached is treated with dyes that stain the tissue, which allows the individual cells in the tissue to be seen more clearly. The slide is then given to the pathologist who examines the tissue looking for any abnormal findings. Depending on the result, the pathologist might request additional studies such as Immunohistochemistry, ER/PR/HER2-Neu, FISH, etc.

Immunohistochemistry

Test Description

Immunohistochemistry or IHC refers to the process of localizing antigens (eg. proteins) in cells of a tissue section exploiting the principle of antibodies binding specifically to antigens in biological tissues. [1] Immunohistochemical staining is widely used in the diagnosis of abnormal cells such as those found in cancerous tumors. Specific molecular markers are characteristic of particular cellular events such as proliferation or cell death (apoptosis). Visualising an antibody-antigen interaction can be accomplished in a number of ways. In the most common instance, an antibody is conjugated to an enzyme, such as peroxidase, that can catalyse a colour-producing reaction.

Special Stains

Test Description

Biological tissue has little inherent contrast in either the light or electron microscope. Staining is employed to give both contrast to the tissue as well as highlighting particular features of interest. Hematoxylin and eosin (H&E) is the most commonly used light microscopical stain in histology and histopathology. Hematoxylin, a basic dye, stains nuclei blue due to an affinity to nucleic acids in the cell nucleus; eosin, an acidic dye, stains the cytoplasm pink. Uranyl acetate and lead citrate are commonly used to impart contrast to tissue in the electron microscope.

There are hundreds of various other techniques that have been used to selectively stain cells and cellular components. Other compounds used to color tissue sections include safranin, oil red o, Congo red, fast green FCF, silver salts, and numerous natural and artificial dyes.

Cultures

Test Description

SOON…

Cryosection (Frozen Sections)

Test Description

The frozen section procedure is used to perform rapid microscopic analysis of a specimen. It is used most often in oncological surgery. The intraoperative consultation which includes not only frozen section but also the gross evaluation of the specimen, the examination of cytology preparations taken on the specimen (e.g. touch imprints), and aliquoting of the specimen for special studies. The report given by the pathologist is usually limited to a “benign” or “malignant” diagnosis, and communicated to the surgeon operating via telephone. When operating on a previously confirmed malignancy, the main purpose of the pathologist is to inform the surgeon if the surgical margin is clear of residual cancer, or if residual cancer is present at the surgical margin.

HER2/NEU (FISH)

Methodology

Fluorescent In situ Hybridization

Turn Around Time (TAT)

10 days

Test Description

The Abbott® PathVysion HER-2 DNA Probe Kit (PathVysion Kit) is designed to detect amplification of the HER-2/neu gene via fluorescence in situ hybridization (FISH) in formalin- fixed, paraffin-embedded human breast and gastric cancer tissue specimens. In situ hybridization is a technique that allows the visualization of specific nucleic acid sequences within a cellular preparation. Specifically, DNA fluorescence in situ hybridization (FISH) involves the precise annealing of a single stranded, fluorescently-labeled DNA probe to complementary target sequences. The hybridization of the probe with the cellular DNA site is visible by direct detection using fluorescence microscopy.

Clinical Significance

Aid in prediction of response to HER2-directed therapy in patients with breast or gastric cancer. For breast and gastric cancer indication, results from the PathVysion Kit are intended for use as an adjunct to existing clinical and pathologic information currently used as prognostic. The PathVysion Kit is indicated as an aid in the assessment of breast and gastric cancer patients for whom HERCEPTIN® (trastuzumab) treatment is being considered.

Specimen Requirements

Breast and Gastric, Tumor Tissue

Sample Collection, Storage and Transport

Fix tissue in 10% neutral buffered formalin immediately after collection to avoid tissue degradation. Fixative duration 6-72 hours. Formalin Fixed Paraffin Embedded (FFPE) tissues are also acceptable.
Label the specimen vial with Patient Name, Date of Birth (DOB), Sample Type, Date and Time of Collection.
Store and transport at room temperature in 24 hours after collection.

Special Patient Preparation

None

Unacceptable Specimen Conditions

Specimens fixed/processed in alternative fixatives. Insufficient quantity of tumor tissue.

Insurance Pre-Authorization Required

Yes (CPT: 88377)

Chlamydia

Test Description

Chlamydia is the most frequently reported bacterial sexually transmitted disease. If untreated, chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often “silent.”

The COBAS® TaqMan® CT Test, v2.0 is an in vitro nucleic acid amplification test for the qualitative detection of Chlamydia trachomatis DNA in female endocervical swab specimens or male and female urine, using the AMPLICOR® CT/NG Sample Preparation Kit for manual specimen preparation and the COBAS® TaqMan® 48 Analyzer for automated amplification and detection.

Gonorrhea

Methodology

Transcription Mediated Amplification (TMA) and Dual Kinetic Assay (DKA).

Turn Around Time (TAT)

4 days

Test Description

The APTIMA Combo 2 Assay is an automated, target amplification nucleic acid probe test that utilizes target capture for the in vitro qualitative detection of ribosomal RNA (rRNA) of Neisseria Gonorrhoeae (NG or GC) in urogenital specimens.

Clinical Significance

Infection with Neisseria gonorrhoeae (NG) is the causative agent of gonorrhea. Clinical manifestations of NG infections are numerous. In men; acute urethritis presents itself after a 1- 10 day incubation period with urethral discharge and dysuria. Only a small proportion of men remain asymptomatic without signs of urethritis. Acute epididymitis is the most common complication, especially in young men. In women, the primary site of infection is the endocervix. In symptomatic women increased discharge, dysuria, and intermenstrual bleeding may be observed. Pelvic inflammatory disease can occur in 10%-20% of women, combined with endometritis, salpingitis, tubo ovarian abscess, pelvic peritonitis, and perihepatitis. Other gonococcal infected sites in men and women are the rectum, pharynx, conjunctiva, and to a lesser degree the disease presents itself as disseminated gonococcal infection. Infants from infected mothers can develop conjunctivitis.

Specimen Requirements

Urine (First catch, preferred), Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Urine Collection for Male (using Aptima PCR Urine Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Patients should not have urinated for at least one hour prior to specimen collection.
Direct the patient to collect first-catch urine (approximately 20 to 30 mL of the initial urine stream) into a urine collection cup. The collection of larger volumes of urine may reduce test sensitivity.
The first catch urine should be immediately transferred into the Aptima PCR Media tube using the provided disposable pipette. (Note: If the urine specimen cannot be transferred immediately, it can be stored at 2°C to 30°C for up to 24 hours.)
The correct volume of urine has been added when the fluid level is between the two black lines on the tube label.
Re-cap the Aptima urine specimen transport tube tightly. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 30 days of collection.

B: Vaginal swab – Clinician collection (using Aptima Unisex Swab Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Collect: Partially peel open the swab package and remove the swab. Remove the blue- shaft specimen collection swab. Do not touch the soft tip or lay the swab down. If you touch the soft tip, use a new APTIMA Combo 2 Unisex Swab Collection Kit.
Carefully insert the blue-shaft swab into the vagina about 2 inches (5 cm) past the introitus and gently rotate the swab for 10 to 30 seconds.
Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab and then withdraw the swab without touching the skin.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Endocervical swab

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Remove excess mucus from the cervical ostium and surrounding mucosa using the cleaning swab (white-shaft swab in the package with red printing). Discard this swab. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: Insert the specimen collection swab (blue-shaft swab in the package with the green printing) into the endocervical canal. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure adequate sampling.
Withdraw the swab carefully; avoid any contact with the vaginal mucosa.
Align: Remove the cap from the Aptima Unisex Swab Media Tube and immediately place the swab into the transport tube so that the score line is at the top of the tube.
Break: Carefully break the swab shaft at the score line against the side of the tube.
Close: Tightly recap the Aptima Swab. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 60 days of collection.

D: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls 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. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 3 months of collection.

E: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

A: Urine Collection

Patients should not have urinated for at least one hour prior to specimen
Female patients should not cleanse the labial area prior to collecting
If the collected urine contains excess blood (specimen has a dark red or brown color) it should be discarded and not used for testing.

Unacceptable Specimen Conditions

Urine specimens with more than 24 hours of collected without transferred to Aptima Urine media. Urine specimen with volume under or above the black lines, specimen contains excess of blood (has a dark red or brown color), expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

PAP Smear

Test Description

The Papanicolau test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. Significant changes can be treated, thus preventing cervical cancer. An anal Pap smear is an adaptation of the procedure to screen and detect anal cancers.
The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium.

In general, it is recommended that females who have had sex seek regular Pap smear testing. Guidelines on frequency are annually. If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in three to twelve months.[citation needed] If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by colposcopy. The patient may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing.

HER2/NEU

Test Description

After a diagnosis of metastatic breast cancer has been made, Her-2/neu testing may be used as a prognostic marker to help determine how aggressive the breast cancer tumor is likely to be. It is usually ordered along with estrogen and progesterone hormone receptor status tests (ER and PR). The results of these three tests give the doctor information about the person’s likely prognosis and response to specific therapies such as hormone therapy and chemotherapy.

The serum Her2/neu test is sometimes used to monitor Her2/neu-positive breast cancer patients who are receiving cancer therapy including, for example, hormone therapy, chemotherapy, or Her-2/neu targeted therapy. If the level of serum Her-2/neu is initially elevated (greater than 15 ng/mL) then falls, it is likely that treatment is working; if it stays elevated, treatment is not working; and if the level falls then rises, the cancer may be recurring.

Chlamydia Trachomatis

Methodology

Real Time-PCR

Turn Around Time (TAT)

4 days

Test Description

The cobas® CT/NG Test is an automated, in vitro nucleic acid amplification test for the qualitative detection of Chlamydia trachomatis (CT) DNA in urogenital specimens.

Clinical Significance

Infection with Chlamydia trachomatis (CT) is the most frequently reported bacterial sexually transmitted disease (STD) in the United States. CT can cause urethritis, cervicitis, proctitis, conjunctivitis, endometritis, and salpingitis; if left untreated, the infection may ascend to the uterus, fallopian tubes, and ovaries causing pelvic inflammatory syndrome, ectopic pregnancy, and tubal factor infertility. Reiter’s syndrome (urethritis, conjunctivitis, arthritis, and mucocutaneous lesions) has also been associated with genital CT infection. Many infections remain asymptomatic, and high numbers of infected patients may not seek care.

Specimen Requirements

Urine (First catch, preferred), Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Urine Collection for Male and Female (using Cobas PCR Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Patients should not have urinated for at least one hour prior to specimen collection.
Direct the patient to collect first-catch urine (approximately 10 to 50 mL of the initial urine stream) into a urine collection cup. The collection of larger volumes of urine may reduce test sensitivity.
The first catch urine should be immediately transferred into the cobas PCR Media tube using the provided disposable pipette. (Note: If the urine specimen cannot be transferred immediately, it can be stored at 2°C to 30°C for up to 24 hours.)
The correct volume of urine has been added when the fluid level is between the two black lines on the tube label.
Re-cap the cobas urine specimen transport tube tightly. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 30 days of collection.

B: Vaginal swab – Clinician collection

Note expiry date on sample collection vial. Do not use expired vials.
Collect: In one hand, hold the woven swab with the scoreline above your hand and insert the swab about 5 cm (2 inches) into the vaginal opening. Gently turn the swab for about 30 seconds while rubbing the swab against the walls of the vagina. Withdraw theswab carefully. Do not let the swab touch any surface before placing it into the collection tube.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Endocervical swab

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Using the woven swab, remove excess mucus from the cervical os and surrounding mucosa. Discard the swab after cleaning. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: To collect the specimen, hold flocked swab with the scoreline above your hand and insert into the endocervical canal. Gently rotate the swab 5 times in one direction in the endocervical canal. Do not over-rotate. Carefully withdraw the swab, avoiding any contact with the vaginal muscosa.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

D: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls the brush vigorously to further release material. Discard the the brush.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

E: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

A: Urine Collection

Patients should not have urinated for at least one hour prior to specimen
Female patients should not cleanse the labial area prior to collecting
If the collected urine contains excess blood (specimen has a dark red or brown color) it should be discarded and not used for

Unacceptable Specimen Conditions

Urine specimens with more than 24 hours of collected without transferred to cobas PCR media. Urine specimen with volume under or above the black lines, specimen contains excess of blood (has a dark red or brown color), Expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

Neisseria Gonorrhoeae

Methodology

Reak Time-PCR

Turn Around Time (TAT)

4 days

Test Description

The cobas® CT/NG Test is an automated, in vitro nucleic acid amplification test for the qualitative detection of Neisseria gonorrhoeae (NG or GC) DNA in urogenital specimens.

Clinical Significance

Infection with Neisseria gonorrhoeae (NG) is the causative agent of gonorrhea. Clinical manifestations of NG infections are numerous. In men; acute urethritis presents itself after a 1- 10 day incubation period with urethral discharge and dysuria. Only a small proportion of men remain asymptomatic without signs of urethritis. Acute epididymitis is the most common complication, especially in young men. In women, the primary site of infection is the endocervix. In symptomatic women increased discharge, dysuria, and intermenstrual bleeding may be observed. Pelvic inflammatory disease can occur in 10%-20% of women, combined with endometritis, salpingitis, tubo ovarian abscess, pelvic peritonitis, and perihepatitis. Other gonococcal infected sites in men and women are the rectum, pharynx, conjunctiva, and to a lesser degree the disease presents itself as disseminated gonococcal infection. Infants from infected mothers can develop conjunctivitis.

Specimen Requirements

Urine (First catch, preferred), Vaginal/Endocervical Swab, ThinPrep, (See OB/GYN Specimen Collection Media)

Sample Collection, Storage and Transport

A: Urine Collection for Male and Female (using Cobas PCR Kit)

Note expiry date on sample collection vial. Do not use expired vials.
Patients should not have urinated for at least one hour prior to specimen collection.
Direct the patient to collect first-catch urine (approximately 10 to 50 mL of the initial urine stream) into a urine collection cup. The collection of larger volumes of urine may reduce test sensitivity.
The first catch urine should be immediately transferred into the cobas PCR Media tube using the provided disposable pipette. (Note: If the urine specimen cannot be transferred immediately, it can be stored at 2°C to 30°C for up to 24 hours. )
The correct volume of urine has been added when the fluid level is between the two black lines on the tube label.
Re-cap the cobas urine specimen transport tube tightly. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 30 days of collection.

B: Vaginal swab – Clinician collection

Note expiry date on sample collection vial. Do not use expired vials.
Collect: In one hand, hold the woven swab with the scoreline above your hand and insert the swab about 5 cm (2 inches) into the vaginal opening. Gently turn the swab for about 30 seconds while rubbing the swab against the walls of the vagina. Withdraw theswab carefully. Do not let the swab touch any surface before placing it into the collection tube.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

C: Endocervical swab

Note expiry date on sample collection vial. Do not use expired vials.
Clean: Using the woven swab, remove excess mucus from the cervical os and surrounding mucosa. Discard the swab after cleaning. Note: Cleaning excess mucus from the cervical os is required to ensure an adequate sample is obtained for processing.
Collect: To collect the specimen, hold flocked swab with the scoreline above your hand and insert into the endocervical canal. Gently rotate the swab 5 times in one direction in the endocervical canal. Do not over-rotate. Carefully withdraw the swab, avoiding any contact with the vaginal mucosa.
Align: Remove the cap from the cobas® PCR Media Tube and lower the swab specimen into the tube until the visible scoreline on the swab is aligned with the tube rim. The bud of the swab should not be submerged into the liquid prior to breaking the shaft.
Break: Carefully leverage the swab against the tube rim to break the swab shaft at the scoreline.
Close: Tightly recap the cobas® PCR Media Tube. The specimen is now ready for transport. Discard the top portion of the swab. Label the sample tube with two patient identifiers and place it with a laboratory requisition in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

D: Endocervical ThinPrep using Plastic Spatula and Brush

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the ectocervix using a plastic spatula. Select the contoured end of the plastic spatula and rotate it 360º in a clockwise direction around the entire ectocervix, while maintaining tight contact with ectocervical surface.
Rinse the plastic spatula immediately into the vial by swirling the spatula vigorously in the vial 10 times. Discard the plastic spatula.
Obtain an adequate sampling from the endocervix using an endocervical brush device. Insert the Cytobrush into the endocervical canal until only the bottom-most bristles are exposed. Slowly rotate 1/4 or 1/2 turn in one direction. Do not over-rotate the brush.
Rinse the endocervical brush immediately in the same vial by rotating the device in the solution 10 times while pushing it against the vial wall. As a final step, swirls the brush vigorously to further release material. Discard the the brush.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

E: Cervical ThinPrep using a Broom-like device

Note expiry date on sample collection vial. Do not use expired vials.
If lubrication of the speculum is required, please use warm water. The use of lubricant may interfere with pathology tests. However, if necessary a small amount of water- soluble carbomer-free lubricant should be applied sparingly to the outer portion of the speculum only, avoiding the tip.
Obtain an adequate sample from the transformation zone of the cervix using a cervical sampler (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 brush 360° in a clockwise direction 3–5 times.
Rinse the cervical sampler immediately into the vial by pushing it into the bottom of the vial 10 times, forcing the bristles apart. As a final step, swirls the brush vigorously to further release material. Visually inspect the cervical sampler to ensure that no material remains attached. Discard the collection device. Do not leave the head of the cervical sampler in the vial.
Tighten the cap so that the torque line on the cap passes the torque line on the vial. Do not over-tighten. Label the vial with two patient identifiers, place the vial and pathology request form in a specimen bag, transport and store 2°C to 30°C for up to 1 year of collection.

Special Patient Preparation

A: Urine Collection

Patients should not have urinated for at least one hour prior to specimen
Female patients should not cleanse the labial area prior to collecting
If the collected urine contains excess blood (specimen has a dark red or brown color) it should be discarded and not used for testing.

Unacceptable Specimen Conditions

Urine specimens with more than 24 hours of collected without transferred to cobas PCR media. Urine specimen with volume under or above the black lines, specimen contains excess of blood (has a dark red or brown color), Expired collection and transport vials, specimens contains excess of mucous, swab specimens without Dacron or Flock swab inside.

Insurance Pre-Authorization Required

Not required.

Sputum

Methodology

Cytocentrifuge
Liquid based preparation

Equipment/Instrument

Cytopro
TP Processor 2000
Leica Auto Stainer

Turn Around Time TAT

2-3 days

Test Description

Sputum consist of a mixture of cellular and noncellular elements that are cleared by mucociliary apparatus. It was once the most common respiratory tract specimen because is relatively easy to obtain, with little discomfort to the patient. Sputum cytology is generally reserved for symptomatic individuals.

Clinical Significance

In order to have an adequate specimen, there must be alveolar macrophages present. That indicates a satisfactory deep cough specimen of the lower respiratory tract has been obtained. The sensitivity of sputum cytology for the diagnosis of malignancy increases with the number of specimens examined, from 42% with a single specimen to 91% with five specimens. Th sensitivity of sputum cytology depends also on the location of the malignant tumor: 46% to 77% from central lung cancers but only 31% to 47% from peripheral cancers.

Specimen Requirements

Collecting multiple sputum samples over several days optimizes sensitivity. Early morning, deep cough specimens are preferred. If the patient is not able to expectorate adequately, expectoration can be induced by having the patient inhale nebulized water or saline. Sputum induction increases the detection of lung cancer.

Sample Collection, Storage and Transport

The patient can expectorate into a sterile container. The specimen can be fixed with Saccomanno or Cytolyt solution. Also smears can be directly prepared and immediately fixed in 95% alcohol. Identify specimen container with patient’s name, date of birth, specimen type and collection date.

Complete surgical pathology testing with expertise in:

Oncology and Hematology

Gastroenterology

Genitourinary

Gynecology

Other specialties such as

Extensive Immunohistochemistry menu with both interpretation or technical service only

Fine Needle Aspirations

Processing of frozen and fresh surgical specimens for immediate diagnosis

Consultation services for both hematopathology and surgical pathology

Autopsy Service

Complete molecular testing menu to complement traditional pathology testing when clinically necessary