[Histonet] Surepath V/s thin pre

Mon May 14 15:24:02 CDT 2018

What is you unsat rate with the ThinPrep?  Published rates are as follows.  Are lab runs around 1.5% for ThinPrep.

CATEGORY

5th

10th

25th

50th

75th

90th

95th

UNSATISFACTORY (%)

0.3

0.4

0.7

1.8

2.5

3.2

3.8

It is also important to recognize that unsatisfactory Pap test results carry an increased risk of underlying disease.  One large study found that up to 26% of unsatisfactory specimens were from patients who had atypical squamous cells (ASC) or a squamous intraepithelial lesion (SIL)1.  This translates into your patient having a 4-time greater risk of cervical intraepithelial neoplasia (CIN) 2/3 than patients with a normal Pap test result2.  Clinical correlation and patient examination should be the first steps in delineating the cause of the unsatisfactory diagnosis1. The American Society for Colposcopy and Cervical Pathology (ASCCP) recommends repeating the Pap test on all patients, with the exception of a patient with known HPV positive status.  In these cases, colposcopy could be considered as an alternative to repeat Pap testing.  The suggested time interval for repeat Pap testing is 2 to 4 months.

We tell our providers that they can help decrease the unsatisfactory rate by following these guidelines:
Avoid scheduling or obtaining a Pap test while your patient is menstruating.  While the test can be collected, it is best to avoid it during this time.
During the 2 days prior to the Pap Test, please refrain from:
Intercourse
Douching
Birth control gels, foam or creams
Vaginal medications or creams unless being utilize to help obtain the Pap test
Use of tampons
Use of personal lubricants

If a lubricant is utilized for the collection of the Pap test, please make sure that “carbomer” or “Carbopol” are not in the ingredient list.  Safe lubricants include:
KY Jelly®
Surgilube®
Astroglide®
Crystelle®

References:

  1.  Ransdell, et. al., Clinicopathologic Correlation of the Unsatisfactory Papanicolaou Smear, Cancer Cytopathology, 1997; 81(3)139-143
  2.  Nygård et al. CIN 2/3 and cervical cancer in an organized screening programme after an unsatisfactory or a normal Pap smear: a seven-year prospective study of the Norwegian population-based screening programme, J. Med Screen,11 (2): 70. (2004)

The biggest con to Surepath is that there are a lot of preprocessing steps involved that include centrifugation, resuspension, etc for the cell enrichment to occur.  They do now make a processor that reduces the amount of hands on time with the specimen but this comes at a cost.  The system also takes up a lot of space compared to a couple of T2000 processors if that is what you have in your lab.  As mentioned, if you are moving to Surepath, make sure that you will still be able to offer the same out of the vial testing that you are currently offering on ThinPreps.  Ancillary testing for HPV, chlamydia, gonorrhea and trichomonas are all available from the ThinPrep vial and not necessarily from SurePath.  This may mean your clinicians may have to co collect two or three specimens which can lead to patient dissatisfaction.

From a cytotech’s viewpoint, the SP and TP are both similar to review.  The presentation of the cells are a little different and may require a slight adjustment period for your techs.  The biggest complaint I have heard from a cytotech and pathologist view point is that cells appear in multiple focal plans that can sometimes make the cells in question a little bit of a challenge to interpret.

Making a large switch like this is a big challenge but possible.  By best advice would be to closely develop a list of pros and cons that you have with your current system and compare what the new system will either fix for you or will create more issues.  Neither system is “perfect” and you have to consider your space, workflows, billing and reimbursement within your payor mix, and patient, clinician, pathologist satisfaction.

Joe W. Walker, Jr. MS, SCT(ASCP)
Anatomical Pathology Manager
Rutland Regional Medical Center
160 Allen Street, Rutland, VT 05701
P 802.747.1790  F 802.747.6525
joewalker at rrmc.org<mailto:joewalker at rrmc.org>, www.rrmc.org<http://www.rrmc.org/>
Our Vision:
To be the Best Community Healthcare System in New England
Our Commitment to our Community: We Listen, We Respect, We Care . . . Always.<http://www.rrmc.org/about/>
Joint Commission Accredited | Best Regional Hospital: U.S. News & World Report | Leapfrog Hospital Safety A Rating
ANCC Magnet Hospital Designation® | Healthgrades: Excellence Award for Patient Safety | Healthgrades: Outstanding Patient Experience Award

From: warda hassan <redrose297 at gmail.com>
Sent: Monday, May 14, 2018 1:52 PM
To: Joe W. Walker, Jr. <jwwalker at rrmc.org>
Subject: Re: [Histonet] Surepath V/s thin pre

Dear Joe W. Walker,

Thank you for your feedback on and to pinpoint on areas of interest which requires to be thought on.

We are considering moving totally toward Surepath due to high number of unsatisfactory per year and that is basically from our clinical side NOT due to system.

So if you can share with me your experience on Surepath how it has been and what are pros and cons i would be great full.

Wishing you a nice day
Lujain

On Mon, May 14, 2018 at 9:24 PM Joe W. Walker, Jr. <jwwalker at rrmc.org<mailto:jwwalker at rrmc.org>> wrote:
Lujain,

You'd have to define what "better" mean to you and your laboratory.  I've used both systems in my career.  Each have their pros and cons.  You would also need to define the specimen types you intend to process, i.e. Pap tests only, Pap tests and non-gyn.  Each company now offers a variety of options to help with pre-processing and processing steps.

Other variables to think about is if you are using the system for Pap tests, are you planning ancillary testing from the vial, do providers in your area have a preference, i.e ThinPrep is FDA approved as significantly better than conventional Pap tests, SurePath has same screening results as conventional but with fewer unsatisfactory Pap results.  Depending on your volume, maybe you want to offer both so that your providers have a choice of Pap testing options.  Lastly, are any of your providers looking for HPV primary screening as your choices are limited for this testing offer.

Joe W. Walker, Jr. MS, SCT(ASCP)
Anatomical Pathology Manager
Rutland Regional Medical Center
160 Allen Street, Rutland, VT 05701<https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmaps.google.com%2F%3Fq%3D160%2BAllen%2BStreet%2C%2BRutland%2C%2BVT%2B05701%26entry%3Dgmail%26source%3Dg&data=02%7C01%7Cjwwalker%40rrmc.org%7C236b5240526c44bc98e908d5b9c35a87%7C0e55647d438e4a448437e959c3cf2240%7C0%7C0%7C636619171063167902&sdata=TndP4iEif%2BIiLOu82DNVskhEhGHzR9%2Ffj1GRfcyaNk0%3D&reserved=0>
P 802.747.1790  F 802.747.6525
joewalker at rrmc.org<mailto:joewalker at rrmc.org>, www.rrmc.org<https://na01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.rrmc.org&data=02%7C01%7Cjwwalker%40rrmc.org%7C236b5240526c44bc98e908d5b9c35a87%7C0e55647d438e4a448437e959c3cf2240%7C0%7C0%7C636619171063167902&sdata=TD85%2BnqZYeo3%2F%2B5Ronl3Fu5oSf%2B0n6HnLBWTjv4exzs%3D&reserved=0>
Our Vision:
To be the Best Community Healthcare System in New England
Our Commitment to our Community: We Listen, We Respect, We Care . . . Always.
Joint Commission Accredited | Best Regional Hospital: U.S. News & World Report | Leapfrog Hospital Safety A Rating
ANCC Magnet Hospital Designation® | Healthgrades: Excellence Award for Patient Safety | Healthgrades: Outstanding Patient Experience Award

-----Original Message-----
From: warda hassan via Histonet <histonet at lists.utsouthwestern.edu<mailto:histonet at lists.utsouthwestern.edu>>
Sent: Friday, May 11, 2018 8:45 AM
To: histonet at lists.utsouthwestern.edu<mailto:histonet at lists.utsouthwestern.edu>
Subject: [Histonet] Surepath V/s thin pre

Hello to all

Would like to know from experienced group who had worked on both systems surepath V/S thinprep which one is better and a comparison of the system on Turn Around Time, staffing & most important reporting.

Many Thanks in advance
Lujain
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