Women's health, molecular analyzer and liquid-based pap test

The CISSS de l’Outaouais’s cytology laboratory is facing a major issue. There is a considerable backlog of 10,000 Pap tests that have yet to be analyzed, representing a delay of 7 months – far exceeding the departmental target of just 3 months. This situation is particularly worrying for public health and the cervical cancer screening program. The main factor is a critical shortage of human resources, causing the delay in analysis.

Faced with this challenge, the laboratory management team at CISSS de l’Outaouais has devised a pioneering solution: a complete cervical cancer screening system using liquid-based Pap tests (ThinPrep).

What is a liquid-based Pap test ? This test involves taking a sample of cervical cells with a spatula or brush in the same way as a conventional Pap test. However, instead of transferring the sample directly to a microscope slide, the sample is first placed in a specially designed liquid medium (transport solution). This preserves the cells better and prevents them from dispersing.

The liquid-based Pap test (ThinPrep) thus provides better cell preservation, which can enhance sample quality and reduce the number of unusable samples.

• It is slightly more sensitive than the conventional Pap test, which means it is better at detecting precancerous or cancerous cells.
• Results from the liquid-based Pap test can be used to perform additional molecular tests, such as human papillomavirus (HPV) screening, if needed.
• It is less likely to give false negative results because the cells are better preserved.

The proposed solution is as follows:

1. A single liquid specimen for both cytology (Pap tests) and molecular testing, providing greater patient comfort (due to reduced scratching and irritation).
2. Use of a molecular analyzer capable of processing 275 tests in just 8 hours.
3. Automated sample sorting that sends only HPV-positive samples to the sample transfer analyzer, eliminating the need for manual sample transfer to slides.
4. Use of an automated ThinPrep analyzer to prepare slides from the liquid medium.
5. Slide staining.
6. A cytotechnologist assigned to read slides.

It should be noted that this procedure will also be used for urine cytology analysis.

Failure to implement this project could have serious consequences for women and public health in general. Long delays create backlogs in the diagnosis of cervical cancer for women, increasing risks of medical complications and the need for aggressive treatments. The delays also reduce the quality of care for women in the Outaouais and put unnecessary pressure on the staff.