Effective November 5, 2017, Spectrum Health Regional Laboratory will be implementing the Paris System for reporting Urine Cytology.
Anal cancer incidence, including in situ and invasive carcinoma is on the rise in North America, with a sharp increase over the past several decades. Oncogenic types of human papilloma virus (HPV) have been shown to be the principle cause of both cervical and anal cancer. HPV is the most common sexually transmitted disease in the United States and anal intercourse is a major risk factor for acquiring the infection. Anal cancer affects both men and women; women having the highest overall likelihood of developing carcinomas of the anorectal region. At risk populations for developing anal carcinoma include men who have sex with men, HIV positive individuals (including those without a history of anal intercourse), immunocompromised patients including a history of organ transplant, those with a history of genital warts, and women with abnormal vulvar, vaginal or cervical Pap results.
In 2014 The Bethesda System for reporting of Pap smears was revised. These revisions were published in 2015. We have modified our diagnostic categories to reflect these changes.
Reporting of endometrial cells in women over 40 years of age was changed to reporting endometrial cells in women over 45 years of age.
Recommendations were made to discontinue the use of Low grade squamous intraepithelial lesion (LSIL) with a few cells suggestive of high grade squamous intraepithelial lesion (HSIL). Based on the recommendations in Bethesda 2014, these lesions will be diagnosed as ASC-H in a background of LSIL.
The recommendation clarifies the treatment algorithm for these patients. These patients should have colposcopy. In our experience over 50% of these patients have biopsies diagnosed as high-grade squamous intraepithelial lesion (HSIL).
Safety of our patient and quality of care are of utmost importance. For this reason we require specimens sent to the Spectrum Health Cytology Laboratory be labeled with at least two patient identifiers, (i.e., patient name, birth date and MRN.) We will no longer return to the collection site, unlabeled, mislabeled specimens lacking two patient identifiers or specimen containers with multiple different patient labels. These specimens will be discarded and repeat collection will be necessary.
Procedures to verify correct labeling of patient specimens at the time of collection are recommended. Specimen containers should not be pre-labeled. Variation of the “time-out” procedure used in the hospital and surgical center setting is an excellent way of confirming that the specimen is correctly labeled. This can easily be achieved by having the patient verify his or her name and birth date, by reading the label placed on the specimen container at the time the specimen is collected. This “time out” should occur before the specimen leaves the examination or treatment room.
It is our mission to provide the best and safest care we can to our patients. We know that physicians and other practitioners are required to see patients more efficiently and at times with less than adequate time allowed. Following a “time out” procedure and not pre-labeling specimen containers will prevent errors that may lead to diagnoses being assigned to wrong patients, hence, unnecessary procedures and lack of follow-up for the appropriate patient.
Spectrum Health Laboratory strives to ensure that all marketing of laboratory services is honest, straightforward, fully informative and non-deceptive. The Spectrum Health’s Code of Conduct dictates that quality laboratory practices are followed and laboratory marketing activities must meet all government laws and regulations.