Preparation of cervical screening reports

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Preparation of cervical screening reports

Examples of cervical screening reports conforming to the requirements of the renewed 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. are found in the Supplement. Sample reports.

Cervical screening result

Reported as low, intermediate or higher risk of significant cervical abnormality, or as unsatisfactory for evaluation, based on both the HPV test and (where indicated) reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. (Table 3.2).

Table 3.2. Reporting of cervical screening result

Findings Report
HPV test result Reflex LBCReflex liquid-based cytologyA test performed on a liquid-based cytology sample when there is a positive oncogenic HPV test result. Reflex LBC may allow for the triage of women along different pathways, negative, LSIL and HSIL, glandular. For women who have HPV16 and/or 18, and who are being referred directly to colposcopy, the reflex LBC result would inform the colposcopic assessment.
Oncogenic HPV not detectedOncogenic HPV types not detected by the HPV testing platform. N/A Low risk for significant cervical abnormality
Oncogenic HPV (not 16/18) Negative or pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category. Intermediate risk for significant cervical abnormality
HPV 16/18Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory. Any of the following:
Unsatisfactory
Negative
pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.
pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).+
Any glandular abnormality
Higher risk for significant cervical abnormality
Oncogenic HPV (not 16/18) pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).+
Any glandular abnormality
Higher risk for significant cervical abnormality
Oncogenic HPV (any type) persisting at 12 month repeat following initial oncogenic HPV (not 16/18) Any of the following:
Unsatisfactory
Negative
pLSILPossible LSIL in the Australian Modified Bethesda System is broadly equivalent to ASCUS in US Bethesda system./LSILLow-grade squamous intraepithelial lesionThe low-grade squamous intraepithelial lesion (LSIL) category is the morphological correlate of productive viral infection. It is to be used when the scientist/pathologist observes changes that would have been described as ‘HPV effect’ or ‘CIN 1’ in the previous Australian terminology and represents part of the previous ‘low-grade squamous epithelial abnormality’ category.

pHSILPossible HSIL in the Australian Modified Bethesda System is broadly equivalent to ASC-H in US Bethesda system./HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).+
Any glandular abnormality

Higher risk for significant cervical abnormality
Test not completed for technical reasons N/A Unsatisfactory for evaluation
Oncogenic HPV (not 16/18) Unsatisfactory Unsatisfactory for evaluation
LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.: liquid-based cytology

HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology).+: HSILHigh-grade squamous intraepithelial lesionIn the Australian context, HSIL is used to refer to a cytology predictive of a high grade precancerous lesion (AMBS 2004), or histologically confirmed high grade precancerous lesion (HSIL-CIN2 or HSIL-CIN3 as per LAST terminology). or higher-grade abnormality

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Specimen type

  • Indicate sample medium.
  • Indicate method of collection:
  • practitioner-collected
  • Indicate that the specimen is cervical in origin.
  • self-collected.

Test result(s)

HPV test

  • Indicate the test method used.
  • Indicate the test result:
  • HPV 16/18Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory. detected. (For test platforms that do not distinguish between HPV 18 and 45, use this category to report HPV 18/45.)
  • oncogenic HPV (not 16/18) detected. (For test platforms that separately identify 45,31,33 or other oncogenic types (not 16/18), include any such types in this category.)
  • oncogenic HPV not detectedOncogenic HPV types not detected by the HPV testing platform.
  • unsatisfactory.

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

  • Indicate method of analysis:
  • image assisted
  • manually screened.
  • Report the epithelial cell findings using AMBSAustralian Modified Bethesda System terminology.
  • Include a statement on the presence or absence of an endocervical component.
  • Note the presence of organisms when identified:
  • Trichomonas vaginalis
  • fungal organisms morphologically consistent with Candida spp
  • shift in flora suggestive of bacterial vaginosis
  • bacteria morphologically consistent with Actinomyces spp
  • cellular changes consistent with herpes simplex virus.
  • Note the presence of other non-neoplastic findings when identified (optional):
  • reactive cellular changes associated with:
  • inflammation and repair
  • radiation
  • intrauterine contraceptive device
  • glandular cells after hysterectomy
  • atrophy.

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Recommendation

Concise management recommendations, as set out in these guidelines, should be included in the report.

The recommendation must take account of the woman’s screening history as recorded with the National Cancer Screening RegisterA database of identifiable persons containing defined demographic and health information, established for a specific purpose. In the case of cervical screening or other cancer screening registers, the purpose includes inviting eligible persons for screening, sending reminders when they are overdue for screening, follow up of abnormalities, statistical reporting and research. (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.).

The management recommendations should align with the cervical screening result as follows:

Cervical screening result Rescreen in 5 years
Low risk of significant cervical abnormality Rescreen in 5 years
Intermediate risk of significant cervical abnormality Repeat HPV test in 12 months
Higher risk of significant cervical abnormality Refer for colposcopic assessment
Unsatisfactory Retest in 6 weeks#

#In cases where the HPV test has been performed and reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. is indicated but cannot be performed, the laboratory should not repeat the HPV test on receipt of the repeat sample, but should proceed directly to LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. and then issue a combined report taking account of both tests.

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Preparation of stand-alone LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. reports

LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. will be requested without an HPV test in the following circumstances:

  • at the time of colposcopy (when indicated)
  • where reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. has been reported as ‘Unsatisfactory’ following the detection of oncogenic HPV (not 16/18)
  • following the detection of Oncogenic HPV (not 16/18) in a self-collected sample.

Reporting LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. at the time of colposcopy

LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. on samples taken at the time of colposcopy is not considered a screening test, but rather as part of the assessment process. Accordingly, an over-arching cervical screening report incorporating a risk statement is not required or appropriate in this setting.

  • Indicate sample medium.
  • Indicate method of analysis:
  • image assisted
  • manually screened.
  • Report the epithelial cell findings using AMBSAustralian Modified Bethesda System terminology (2004).
  • Include a statement on the presence or absence of an endocervical component.
  • Note the presence of organisms when identified:
  • Trichomonas vaginalis
  • fungal organisms morphologically consistent with Candida spp
  • shift in flora suggestive of bacterial vaginosis
  • bacteria morphologically consistent with Actinomyces spp
  • cellular changes consistent with herpes simplex virus.
  • Note the presence of other non-neoplastic findings when identified (optional):
  • reactive cellular changes associated with:
  • inflammation and repair
  • radiation
  • intrauterine contraceptive device
  • glandular cells after hysterectomy
  • atrophy.
  • Document that the woman is under gynaecological management and therefore a recommendation is not provided.

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

Where a woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result and the reflex LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. was unsatisfactory, she should have a further cervical sample taken for LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. in 6 weeks. The repeat cervical 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 prepare a cervical screening report (see Preparation of cervical screening reports), 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.. It is anticipated that the support of the National Cancer Screening RegisterA database of identifiable persons containing defined demographic and health information, established for a specific purpose. In the case of cervical screening or other cancer screening registers, the purpose includes inviting eligible persons for screening, sending reminders when they are overdue for screening, follow up of abnormalities, statistical reporting and research. will be critical in this circumstance.

Following self-collection

Where a woman has a positive oncogenic HPV (not 16/18)Women with a positive HPV test result of other oncogenic HPV types other than types 16 and 18 detected using routine HPV testing in a pathology laboratory. test result on a self-collected sample she should have an LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. sample taken by her health care professional. The LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory. specimen 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 prepare a cervical screening report (see Preparation of cervical screening reports), combining the results of the original HPV test result and the LBCLiquid based cytology(LBC) is a way of preparing cervical samples for examination in the laboratory.. It is anticipated that the support of the National Cancer Screening RegisterA database of identifiable persons containing defined demographic and health information, established for a specific purpose. In the case of cervical screening or other cancer screening registers, the purpose includes inviting eligible persons for screening, sending reminders when they are overdue for screening, follow up of abnormalities, statistical reporting and research. will be critical in this circumstance.

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