Cytology

Cytology is situated within the Pathology department at the Royal Stoke University Hospital in the Main Building on Floor 2. It is part of the Pathology Directorate which in turn is part of the Children’s, Women’s and Diagnostics division.

The department is ISO 15189:2012 accredited and processes approximately 95,000 cervical cytology samples per annum for the NHS Cervical Screening Programme, providing a comprehensive service to hospitals and surrounding GP surgeries in Staffordshire, Shropshire and East & Mid Cheshire.

An FNA adequacy service is also provided at dedicated Head & Neck clinics three times per week at UHNM.

The department is responsible for cervical Cytology screening and works closely with the Virology department to provide Human Papilloma Virus (HPV) testing, and as such receives, processes, tests and reports samples whilst working to a 14-day turn-around-time. All patients with abnormal results are directly referred to the 9 Colposcopy units we serve and are followed-up using the failsafe system.

The laboratory processes LBC samples by the BD Surepath™ method only, using the Roche Cobas® platform for HPV testing.

We are open from 8am-5pm Monday-Friday and all Cytology enquiries, including technical advice and results chasing, can be made by phoning 01782 674951. Please call us if you have any doubt at all in taking a sample.

To see more information please click on the titles below which will expand into more detail.

*Please note - we are no longer accepting transport proformas - please write the amount of samples you placed in the bag onto the front of the large pink transport bag and seal to ensure there is no loss of samples*

Issue date: November 2018, CYPOL002 'Cytology User Website', Revision 014

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Clinical advice from a Consultant Pathologist/Consultant BMS is available. In addition, for sample requirement queries or acceptance queries, a Duty BMS is available. Please telephone during normal working hours.

Cytology Laboratory (results and general information)  nos-tr.cytology.queriesuhnm@nhs.net 01782 674229 / 674951
Fax 0844 272 9770
Dr Nichola Cooper, Consultant Pathologist, Cytology Clinical Lead   Nichola.Cooper@uhnm.nhs.uk 01782 674840
Dr Gill Douce, Consultant Pathologist, Cervical Screening Provider Lead & Network Manager    Gill.Douce@uhnm.nhs.uk 01782 674843
Sarah Fish, Lead BMS    Sarah.Fish@uhnm.nhs.uk 01782 674229
Joanne Hallchurch, Consultant BMS    Joanne.Hallchurch@uhnm.nhs.uk  01782 674229
Stephen Bird, Consultant BMS    Stephen.Bird@uhnm.nhs.uk 01782 674229

Cytology Department

Royal Stoke University Hospital

Floor 2, Main Building

Newcastle Road

Stoke-on-Trent

ST4 6QG

User survey feedback 2018

We received a staggering 91 responses from users this year! Thanks to all who sent in a response. You were 88% satisfied overall with our service - this is great, but we'd like to do better!

Positive comments

Here are some of the positive comments we received and raised as plaudits:

'The dept. staff are always very polite, helpful and professional.'

'Compared to some areas in the country, your  turnaround time is great!'

'I think they are doing a great job and should be congratulated on the service they are providing.'

'It works satisfactorily with good access to lab for advice, good provision of supplies and quick turn around. '

Areas for improvement

Here are some areas requiring improvement, where we have received more than one response with the same subject:

You said....

We did.....

Regarding Call/recall: 'Communication is slow and not effective enough', 'it would be beneficial to be able to speak to a person about a patients past cytology or queries re recall but it has to be done by email', 'it takes ages to get a response to queries', 'Open exeter is not always up to date', 'Errors occur affecting confidence in the system - it should be completely robust. '

We fed back your comments to Call/recall so they can work to improve communication

Regarding supplies: 'sometimes there is a delay in receiving supplies', 'last order was not received by supplies took numerous phone calls to arrange delivery'

We looked into the areas where the most delays take place and have discovered an issue with transport - we are working with supplies and transport to fix this

Regarding endocervical brushes: 'Would like a greater supply of endocervical brushes', 'Too few are sent each time'

We will now be sending a larger amount of brushes out to practices who send in more cervical specimens

Regarding inadequate results & rejections: 'Inadequate/ rejected smear results need better clarity as to the reason why not processed', 'sometimes it is not clear why patients have an inadequate', 'I’m irritated when on occasions samples get rejected stating they are unlabelled or in old bottles'

All reports with an 'inadequate' result have been processed. Further information on reasons for inadequates can be found in Section 5 of the website. We follow the national policy for rejection of samples - reasons for rejection are included in the national rejection letter - please see Section 8.

We will look into individual issues raised and contact those with concerns. In addition, we will be setting up some sample taker tours for anyone interested who has never visited our laboratory - invites will be sent via email to those who took the time to respond to our user survey.

User survey

We issue a user survey every 15 months. If you haven't received one, please let us know. The latest user survey feedback can be seen above.

Complaints

If you have any complaints about the service the department provides please contact the Lead BMS on the number or email above.

Patients should contact PALS ON 01782 676450/676455/676435.

Plaudits

We like to feed back to staff when they're doing a good job! Please email or call if you have some positive feedback for us.

Please ensure that samples are only being taken by nurses, GPs or consultants trained in taking cervical smears for the Surepath method and that they have been issued a sample taker PIN. If the lab receives a sample taken by an untrained medical staff member it will be reported as inadequate. The sample taker PIN is a unique identifier and must be not be shared and has to be included on the request form.

If you are trained in taking Surepath LBC samples but have only just moved into the area please contact the lab so we can add your PIN to our list. 

Furthermore please be sure that the woman is due a smear before taking a sample and sending it to us. She should have received a letter advising her to attend for a cytology screening test however if you are unsure please check Open Exeter’s Reports section.

All sample takers should have a personal identification number (PIN) which is registered with the department. Sample takers based in Staffordshire may have been issued with codes during their training. Those that have not been issued with a code and sample takers based in Cheshire or Shropshire, will use their GMC or NMC code.

 

Please note that you should not use another person’s PIN code or allow another person to use yours. If someone is acting in a training capacity (for registrars who will only be taking a couple of samples) please make that clear on the request form.

 

Trainee sample takers from Staffordshire and Shropshire will be allocated a trainee PIN by the regional sample taker database support service at Kettering General Hospital. Once trained, they will allocate a permanent PIN. GMC and NMC codes are usually used with a T prefix for trainees. For further information about sample taker PINs, please contact kgh-tr.SDBSupport@nhs.net

Trainee sample takers from Cheshire will be allocated a trainee PIN by the Screening & Immunisation team for Cheshire. Please request a form from england.cm-imms@nhs.net. Once trained and for existing sample takers new to the area, the laboratory will allocate a permanent PIN - please contact us at nos-tr.cervicalpinrequest@nhs.net. GMC and NMC codes are usually used with a T prefix for trainees.

 

The laboratory keeps a record of discrepancies on forms and vials as well as issuing inadequate rates to the Screening & Immunisation teams. These are audited via the PIN code.

When receiving a cervical specimen, it is important that sufficient relevant clinical information is given.  Relevant clinical information includes:

  • Any previous abnormal specimens (e.g. Loop biopsies, punch biopsies)
  • Any previous treatment (e.g. Thermo/Cold coagulation)
  • Details of any hormones including contraception
  • IUCD in situ
  • Any symptoms of abnormal bleeding
  • Whether the patient is pregnant/post natal

    This will help in the interpretation of the cervical specimen and also ensure that the correct follow up management is given. By presenting herself for cervical screening, the patient has consented to the procedure.

The screening intervals set by NHSCSP for routine samples in England are:

Aged 25-49:     every 3 years

Aged 50-64:     every 5 years

Routine recall is indicated by ‘A’ on the HMR101 form.

Patients with a prior abnormality should have repeat tests as recommended – these will be given the code ‘R’ on the HMR101 form, as well as previous inadequate results.

Patients with a negative HPV result may be given the ‘R’ code due to a recommended repeat of 36 months – this ensures the patient is called back for a repeat test as follow-up in 3 years, but is not deemed as a ‘normal recall’.

When a patient has a suspended recall, indicated by an ‘S’ code, they have been under the care of colposcopy and the follow-up interval should be provided by colposcopy. Please check ‘Cervical Cytology Reports’ on Open Exeter which will show the true recall date and may have further information in the ‘notes’ section.

Inadequate results

The main reason that a cervical specimen is reported as inadequate is that it contains too few cells for a reasonable decision to be made. It is safer to ask women to return for a repeat specimen so we can look at more cells. Another reason is too much blood or polymorphs present in the sample. Although LBC removes a lot of the blood, cervical specimens taken in women who are bleeding heavily can deem the specimen to be inadequate. It is not the fault of the sample taker - there is roughly a 2.5% inadequate rate of all specimens we receive.

If we receive a specimen from someone with an invalid PIN or no PIN, we should reject it. However, we do process these specimens to check if there are any abnormal cells, as this is better for the woman. On receipt of a valid PIN, an amended report is issued if the sample was deemed negative.

Please note: samples must not be taken less than 12 weeks after an inadequate result - these will be automatically rejected.

Electronic reports

Many areas now receive electronic only results. These may look different to the paper format. There are sub headings on the report - please ignore 'Request: LBC specimen' for the purposes of results - this section is only used to indicate failsafe information for the patient. The important section to read is 'Observations', where the results should show under 'Cytological pattern' (e.g. Negative) and the recall should show under 'Management suggested' (e.g. Normal recall).

Individuals taking cervical specimens must have attended a specimen taker course and completed their training log book, including a visit to the laboratory for a tour and general overview (please call to book onto a tour).  Before taking specimens they must register as specimen takers with the laboratory. A cervical sample taking resource pack and toolkit is available within GP practices and hospital clinics for guidance on taking the specimen.  In addition, an instructional video can be viewed on the BD website at this location: https://www.bd.com/en-us/company/video-gallery?video=4385129906001. However, please note that the 2D barcode labels should not replace patient identifiable data – minimum requirements for both the vial and form must still be met.

Once the BD Surepath™ LBC specimen is taken, the head of the sampling device (cervical broom) must be removed from the handle by a simple flicking with the thumb while the head is within the vial.  The vial must be labelled with the patient’s surname, forename and date of birth and/or NHS number.

At this stage please ensure that the details on the vial are fully completed and that they match those on the Open Exeter request form.

We recommend that the details on the vial and request form are completed in-front of the patient and that the patient’s name and date-of-birth is read out loud. The lid on the vial must be screwed on tight enough not to leak into the bag.

If an endocervical brush specimen is also taken (for example the patient has a stenosed os due to previous treatment or the patient has had a previous endocervical abnormality) the head of this sampling device must be removed by utilising the brush remover that is present within the pack.  The brush head must be placed into the same vial as the cervical broom specimen.  Please note on the request form if a brush and a broom sample have been taken.

A brush specimen must not be used in isolation- a cervical broom specimen must be taken as well.

A sample that lacks the minimum information required for cervical samples may be rejected and the patient will need to return in 12 weeks for a repeat test.

Identifier

Minimum identifying requirement for cervical samples

1

Patients full name i.e. first name and surname.

2

Patients date of birth.

3

Preferred third identifier: NHS number.

Acceptable third identifier: patients address.

As the turn-around-time begins once you take the sample, we ask that the samples are not batched together but instead send them in at the soonest available time. Vials should be stored at room temperature.

Please send in HMR101 Open Exeter forms, accessed via the Open Exeter website, as these are applicable to the cervical screening programme and come with the patient’s history. Hand written forms are difficult to read and may not contain all the information we need.

The link to Open Exeter is here: https://nww.openexeter.nhs.uk/nhsia/index.jsp

Ensure you complete all sections highlighted below:

When filling in the HMR101 form – editable, please click on A5 HMR101PDF (2009) and print the form that opens.

If you have problems accessing Open Exeter a hand-written HMR101 form is acceptable as long as it is filled in correctly. This can be found in the ‘Help’ section of the Open Exeter website under the ‘Cervical Screening’ section, blank forms can be downloaded at the bottom of that page. An incomplete form leads to a significant delay in patient results or possible rejection.

The department follows the National Acceptance Policy for Cervical Cytology Samples, available to view on the Public Health England website: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/669132/Guidance-for-acceptance-of-cervical-screening-samples.pdf

The policy outlines criteria for acceptance. If a specimen is rejected, a standardised rejection letter is sent out to the sample taker with an explanation of the reason for rejection and an expected date for the test to be repeated. Errors relating to specimens taken as part of the cervical screening programme are recorded and reported to Screening and Immunisation leads.

The laboratory checks all samples in order to identify discrepancies which then are divided into two categories: ‘Major’ and ‘Minor’.

A Minor discrepancy means that even though there is an error with the sample it will still be reported. These errors mostly include 'no valid PIN provided' and 'name or date of birth incorrect by one digit'.

These constitute Minor discrepancies because we can check our own records, and those of Open Exeter, in order to positively identify a patient. Even though these types of error will result in a report being issued, resolving these discrepancies takes valuable time away from many members of staff.

A Major discrepancy results in the sample being rejected, and is commonly due to one of the following reasons:

  • E1: Vials without forms
  • E2: Forms without vials
  • E3: Unlabelled vial (these are always rejected as we cannot confirm which patient the vial belongs to – please take extra care)
  • E4: Partially labelled vial
  • E5: Mismatched vial and form
  • E6: Insufficient patient identifiers between vial and form
  • E8: Invalid sample taker PIN
  • E10: Vial in poor condition - Leaked vial, Out of date vial, Damaged vial, No broom in vial
  • E12a: Woman aged under 24 years and 6 months
  • E12b: Woman aged over 65 years
  • E12c: Vault samples from GPs (these are only accepted from Gynae & Colp clinics)
  • E12d: Samples received too early after a previous test (please check Open Exeter if you are unsure whether the patient is due for her test).

These are common mistakes, so please be vigilant when taking and labelling all samples.

It is not necessary to take additional cervical samples outside of the Screening Programme. Women with symptoms should be referred to a Gynaecologist as the laboratory will not accept a sample taken from a GP before the due date.

The HMR101 request form and specimen vial should be placed individually in a small specimen bag and then all samples should be placed in a large pink transport bag, which should be sealed once all samples have been placed in it. Please record the number of samples sent on the front of the bag. Please do not place any other specimens for Pathology into the large pink bag as we cannot guarantee they will be passed on in a timely manner, so this could be detrimental to the test.

Samples should be sent to the laboratory as soon as possible to facilitate 14 day turnaround times and stored at room temperature.

All cervical cytology specimens are transported to your local hospital via GP transport couriers. They are then collected from surrounding hospitals by UHNM couriers. Consumables from the supplies department are also sent out in this way, from UHNM to local hospitals and on to individual GP surgeries. If you have any problems with specimen transport, please give us a call.

The Supplies Department at the Royal Stoke University are the suppliers for all Surepath LBC consumables necessary for taking cervical cytology samples. Consumables are ordered from BD.

To request stock please complete an order form supplied by the Supplies department and return by fax. The form can be found here: https://uhnmpathology.com/files/Order%20Forms/pathology-order-sheet-gps-v7-2-.pdf?c61068e703. If you require endocervical brushes, which should rarely be used and never in isolation, please contact the laboratory directly on 01782 674229.

LBC vials, cervix brushes and endocervical brushes should all be stored at room temperature on open shelves. We do not recommend that sample takers store vast quantities of stock and it should be rotated on a regular basis in order not to exceed the use by date.

In May 2016 the type of LBC vial used to take Surepath specimens changed to the below image. If the vials you use do not have the three plastic lugs please dispose of them as they may crack.

There are 36 members of staff who make up the Cytology team - here's what they do!

Healthcare Science Support Workers: Carry out vital patient ID checks, make sure we accept the right specimens at the right intervals, enter requests onto the IT system, prepare samples for processing, slide filing & scanning of documents

Medical Laboratory Assistants & Associate Practitioner: Do all of the above, create slides of cells in their best state and stained so those reporting can see the cell features clearly, keep the lab stocked up, make sure the work flows, write up the rota, supervise staff

Cytoscreeners: Make difficult and important decisions every day to separate those who need further investigation from those who don’t by reporting all negative and inadequate samples and escalating abnormal specimens to senior staff

Biomedical Scientists, Senior Biomedical Scientists, Lead Biomedical Scientist: Do all of the above and are there to keep the quality of the service through audits, telephone advice, quality control of slides and keep staff up to date with training and competence, line manage staff, ensure the department meets ISO 15189:2012 standard and provide the FNA adequacy service

Consultant BMS & Pathologists: Decide the grade of the abnormal specimens & send some for HPV testing so clinicians know what to do next, carry out reviews of cases, attend review meetings at hospitals to give advice, carry out clinical audits, attend external meetings & run the training for the department and SHOs, overall management of the laboratory and screening programme at UHNM

Failsafe Support Officers, Failsafe Officer/Team Lead, Cytology Network Support Manager: Make sure results go out to the right patient and sender, make sure that patients are referred to the right clinic and have appointments, follow them up to check they attended, make sure results go to call/recall so the patient gets a result letter, provide secretarial support, produce statistics, run the invasive review audit, keep track of where specimens are so they don’t breach, minute meetings, line manage staff

The Cytology laboratory no longer process Non-gynaecological specimens – this has been transferred to Histology.  However, a Fine Needle Aspiration adequacy assessment service at Royal Stoke is still provided by the Cytology Biomedical Science team to support the Non-gynae service. Dedicated head and neck clinics are attended by the team three times a week. If you require an ad hoc preparation with adequacy assessment at Royal Stoke, please call to arrange this, giving as much prior notice as possible and we will try to accommodate your request.

For further information on Non-gynae Cytology, please visit the Histology section of our website.