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Logistics hurdles overcome for single Pap-HPV report

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Logistics hurdles overcome for single Pap-HPV report

Is one test better than two? That question—primary HPV versus the Pap-HPV cotesting option—has roiled the world of cervical cancer screening since the Food and Drug Administration approved a primary HPV screening test in April 2014. However clinicians decide to answer that question, this much is clear: A single report is better than two separate results.

That was the conclusion that leaders at Northwestern Memorial Hospital’s cytopathology laboratory came to in concert with their ob-gyn colleagues after changes were made to cervical cancer screening and management guidelines. At Northwestern, the high-risk HPV/genotyping and the cervical cytology results are combined into a single report that is sent to clinicians through the electronic health record system.

Dr. Nayar

“The clinician needs both results in the case of cotesting [Pap and HPV] and reflex HPV or reflex cytology orders, to make follow-up decisions,” says Ritu Nayar, MD, medical director of Northwestern’s cytopathology laboratory. “Getting the results separately creates extra work at the clinical end since the clinician has to look at two separate results, often at two different times before proceeding with patient management.”

While simple in concept, achieving the combined Pap-HPV report was no easy task, says Dr. Nayar. She is a professor of pathology at Northwestern University’s Feinberg School of Medicine and director of the cytopathology fellowship program at Northwestern’s McGaw Medical Center.

“The issues we had to tackle before implementation included the logistics of combining a clinical pathology-type result with an anatomic pathology report, who would do it, how, what impact ‘informed cytology’—knowledge of the HPV result when looking at the Pap test—would have on cytotechnologists and pathologists, and what the resultant time delay in such a report would be,” she says. After examining workflow and turnaround times, the cytopathology laboratory’s leaders decided it would make the most sense for cytotechnologists to add the HPV result to the cytology report for cotesting and reflex testing.