hpv workflow through the cytology lab and practical dilemmas kath hunt southmead hospital...
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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 2nd 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 e-mail 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 e-mails!
Any Questions?