HPV Workflow through the Cytology lab and Practical Dilemmas Kath Hunt Southmead Hospital

History Site for original trial in 2001 Started testing as part of Sentinel Sites on the 2 nd January 2008 Triage cases and test of cure (TOC) on first follow up after treatment Then brought in TOC on any specimen during the ten year follow up

Lab Requirements Space – some more specialised Storage space – kit sizes vary, consumables Fridge Space Freezer space (-18)

Space

Staffing Majority of methods now automated and walk away Band 4 graduate MLAs and BMSs prepare samples and run assay Couple of ‘Superusers’ who troubleshoot

Lab Training For most systems training is two to three days either on site or at HQs Lead in period of gaining confidence Validation run with samples provided by Edinburgh reference lab Two staff suggested by NHSCSP, this will not be enough in reality

Sample Taker Training For Sentinel sites we relied on Sample takers knowledge from previous trial Four years on still some confusion Repeat samples taken too soon Brought up at every update day

Work Throughput- Triage Primary screen – adds result code and screeners HPV code Borderline ‘H8, Mild ‘H3. Checker verifies Consultant (includes Con BMS) changes ‘H code to ‘TEST’ This triggers the case to be picked up in search

Work Throughput - Triage HPV result is returned to Consultant to be added to report and management added In their absence another Consultant can add the result plus a Senior and Lead BMS have been trained to cover when necessary unless a complicated case

Work throughput - Triage Important point – as the HPV result could be added by another Consultant the original result and any free text report must be added by the original Consultant who viewed the slide Do not use HPV test to decide whether difficult cases are positive Do not assume numerical values are truly quantitative – depends on cellular content

Work Throughput - TOC Primary screener adds ‘H2 code to all TOC cases Checker changes this to ‘TOC’ this triggers it to be picked up on the search HPV result is returned to checker for adding to report and signing out. This includes Colp referrals for positive tests. In their absence any checker can add result.

Work Throughput and LEAN Twelve o’clock cut off for HPV requests unless urgent/breaching List is run from Ultra which picks up the ‘TEST’ and ‘TOC’ codes Vials retrieved from rack ‘Tubing up’ – hopefully a thing of the past! Samples run on QIASymphony, can be added all day if necessary in small batches

Work Throughput and LEAN Plate stored overnight in fridge or left on cooling tray in Symphony In the morning the plate is put on the Rapid capture System Results printed out at lunchtime and added to Ultra Can both be run same day but results come off last thing

LEAN/ 14 day TAT Does add at least 24 hours onto TAT More if sending off site Financially more sensible to batch if TATs short enough Need reliable regular transport arriving at right time of day

IT Platform to link to LIMs Reliable IT link/secure for off site testing Result codes and HPV codes for LIMs Map codes to PCSA codes Report wording Patient letter wording

Other thoughts Reprocessing – None of the platforms CE marked for Espostis samples. Recent paper shows that it works on HC2 Potential other tests you might want to carry out (Chlamydia, GC?) Fluctuating test numbers over first 2-3 years

Other thoughts Colposcopy returning patient to routine recall – how is this communicated to the PCSA? I’m more than happy to take phone calls or s!

Any Questions?