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Cervical cancer screening

4. Unsatisfactory cervical screening results

Clinical question

GUIDELINE UPDATES - This guideline was last updated 8/15/2018

UPCOMING GUIDELINES - This guideline was updated and comes into practice on 7/1/2022Download PDF

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 LBC

The Bethesda System 2014 (TBS 2014)[1] defines an unsatisfactory LBC preparation as one with fewer than 5000 well-visualised, well-preserved squamous or squamous metaplastic cells. TBS 2014 provides extensive practical guidance for laboratories.[1]

Practice point
REC4.1: Attempt adequate repeat preparations for an unsatisfactory LBC test
In the case of unsatisfactory LBC, laboratories should ensure that adequate repeat preparations are attempted, after dealing with potentially remediable technical problems.

When reflex LBC 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 HPV. The laboratory should undertake LBC and then prepare a cervical screening report combining the results of the original HPV test and the repeat LBC (see Preparation of cervical screening reports in Chapter 3. Terminology). It is anticipated that the support of the NCSR will be critical in this circumstance.

When reflex LBC is unsatisfactory, but the woman requires colposcopic referral regardless of the LBC result, then the screening episode should be reported as ‘Higher risk for significant cervical abnormality’. LBC should then be performed at the time of colposcopy.

Application

The laboratory should state why the screening sample is unsatisfactory: either because the HPV test or the LBC could not be completed. In the case of unsatisfactory LBC, the laboratory should report why the sample is unsatisfactory.

Practice point
REC4.2: Report cellular abnormality for LBC specimens with abnormal cells
Any LBC specimen with abnormal cells should not be reported as ‘Unsatisfactory’. The identified cellular abnormality should be reported.

Management of Unsatisfactory Screening Samples

Practice point
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.

Management of Unsatisfactory Screening Samples

Practice point
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.

Author(s):

In the renewed National Cervical Screening Program (NCSP), unsatisfactory screening results may occur either because the HPV test cannot be performed or because liquid-based cytology (LBC), when indicated, cannot be evaluated. 

References

  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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