4. Unsatisfactory cervical screening results

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In the renewed National Cervical Screening Program (NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.), unsatisfactory screening results may occur either because the HPV test cannot be performed or because liquid-based cytology (LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.), when indicated, cannot be evaluated.

Unsatisfactory HPV tests

HPV tests can be unsatisfactory because of the effects of inhibition or, in the case of some tests, because the internal control failed to demonstrate the presence of human DNA in the sample. If the HPV test cannot be performed, then the screening episode should be classified and reported as ‘Unsatisfactory’.

Unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.

The Bethesda System 2014 (TBSThe Bethesda System 2014)[1] defines an unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. preparation as one with fewer than 5000 well-visualised, well-preserved squamous or squamous metaplastic cells. TBSThe Bethesda System 2014 provides extensive practical guidance for laboratories.[1]
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REC4.1: Attempt adequate repeat preparations for an unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. test
In the case of unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory., laboratories should ensure that adequate repeat preparations are attempted, after dealing with potentially remediable technical problems.

When reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is unsatisfactory in a case where it was required to determine whether the woman should be referred for colposcopic assessment or should have a repeat test in 12 months, then the screening episode should be classified as ‘Unsatisfactory’ and retesting in 6 weeks should be recommended.

At retesting, the repeat sample should not be tested for HPVHuman papillomavirus. The laboratory should undertake LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. and then prepare a cervical screening report combining the results of the original HPV test and the repeat LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. (see Preparation of cervical screening reports in Chapter 3. Terminology). It is anticipated that the support of the NCSRNational Cancer Screening Register will be critical in this circumstance.

When reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is unsatisfactory, but the woman requires colposcopic referral regardless of the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. result, then the screening episode should be reported as ‘Higher risk for significant cervical abnormality’. LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. should then be performed at the time of colposcopy.

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Application

The laboratory should state why the screening sample is unsatisfactory: either because the HPV test or the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. could not be completed. In the case of unsatisfactory LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory., the laboratory should report why the sample is unsatisfactory.


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REC4.2: Report cellular abnormality for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. specimens with abnormal cells
Any LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. specimen with abnormal cells should not be reported as ‘Unsatisfactory’. The identified cellular abnormality should be reported.

Management of Unsatisfactory Screening Samples

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REC4.3: Recall women in 6−12 weeks if they have an unsatisfactory screening report
A woman with an unsatisfactory screening report should have a repeat sample collected in 6–12 weeks. If the reason for the unsatisfactory sample has been identified then this problem should be corrected if possible before the repeat sample is collected.

References

  1. 1.01.1 Nayar R, Wilbur DC, editors. The Bethesda system for reporting cervical cytology: definitions, criteria and explanatory notes. Third edition. New York: Springer International Publishing Switzerland; 2015.
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