Anatomic Pathology CONSULTATION SERVICES

Dermatopathology

Expert dermatopathology consultative services are offered in a wide range of neoplastic and inflammatory diseases of the skin. Refer to Consultation, Dermatopathology in the Laboratory Test Directory.

Head and Neck Pathology

Dr. Gary L. Ellis is the director of oral and maxillofacial pathology and provides expert consultative services for inflammatory diseases and neoplastic disorders such as odontogenic tumors, inflammatory diseases of the major and minor salivary glands, giant cell lesions of the jaw, and temporomandibular joint diseases. To submit cases for consultation, refer to Consultation, Head & Neck in the Laboratory Test Directory.

Hematopathology

Hematopathology provides a broad range of special hematology and specialized anatomic pathology testing. The department houses nationally and internationally known experts who provide consultative services and test result interpretation. Bone marrow services are also available. Please refer to Bone Marrow. To submit cases for a hematopathology consultation, refer to Consultation, Hematopathology.

Neuropathology

Neuropathology provides diagnostic information for unusual neuromuscular disorders with subtyping capabilities for muscular dystrophy. Neuropathology assists the community pathologist with a multitude of disorders, including brain tumors, CNS infection, and neurodegenerative diseases. To submit muscle or nerve biopsies, refer to Muscle/Nerve Biopsy Special Studies. For nerve fiber anaylsis, refer to Intraepidermal Nerve Fiber Density Analysis.

Renal Pathology

Renal Pathology special studies provide the community pathologist with diagnostic support, therapeutic monitoring, as well as transplant monitoring for rejection. Services are available for determination of recurrent or de novo kidney disease in transplant patients. To submit renal biopsies, refer to Renal Pathology Special Studies.

Surgical Pathology

Surgical Pathology is staffed by full-time university faculty. The faculty’s expertise in a wide variety of subspecialties enables the department to support ARUP’s clients throughout the United States. Diagnostic and consultative services are available. To submit cases please refer to one of the following:

Specimen Submission

All submissions require an Anatomic Pathology test-request form. Please see individual listings in the Alphabetical Test List for specimen requirements and submission guidelines. If you have questions, please contact your ARUP business development manager, our Anatomic Pathology business development manager, or Anatomic Pathology directly at (800) 348-2787.

Cytopathology

The Cytopathology Laboratory at ARUP is a full-service department providing routine screening and diagnostic cytopathology services, including gynecologic and nongynecologic specimens (pulmonary and bronchoalveolar lavage, gastrointestinal, body cavity fluid, cerebrospinal fluid, urologic, fine needle aspiration, Tzanck smears, nipple secretions, anal cytology, and ophthalmologic cytology). Special studies can also be performed on nongynecologic specimens including flow cytometry, UroVysion™ FISH, bladder tumor associated antigen, and immunocytochemical studies. The Cytopathology Department extends leading technology by offering Focal Point™ slide profiler, SurePath® liquid-based Pap test, and ThinPrep® Pap Test™. Call Cytology at (800) 242-2787, extension 5031, for information concerning the available technologies. Cytology services are provided through arrangements made with your business development manager.

Laboratory Services

Refer to individual tests in the Alphabetical Test List for information on collection and transportation requirements. Tests are listed under Cytology, followed by the specific test name.

Consultations are available on all cytologic materials. Submit all materials (slides and blocks) with original pathology report, clinical history, and an ARUP Cytology or Anatomic Pathology test request form designating that the case is for consultation.

Specimen Submission

Collection Supplies—Cytology supplies may be obtained from ARUP Client Services at (800) 522-2787 or by faxing an order to (800) 522‑2706. Additional supply order forms may be requested from Client Services. Please order supplies at least two weeks in advance of actual need to keep cost at a minimum, as the collection kits for ThinPrep® and SurePath® tests contain flammable liquid and are limited to ground shipment. All orders are reviewed by the Cytology section to verify that requested supplies match estimated workload to provide optimal availability of supplies and to minimize costs for all clients. Rotate stock of PreservCyt® and Surepath® and use vials with closest expiration date first. No specimen will be accepted in expired solution.

Specimen Labeling—Label all specimens legibly with the patient’s first and last name, date of birth, and any other client-specific identifier on all materials submitted for testing. Glass slides need to be labeled on the frosted end in pencil. Outer shipping container labeling will NOT be acceptable for specimen identification.

Cytology Test Request Form

Cytology specimens must be submitted with a completed ARUP Cytology test request form #289-0903. The patient’s first and last name, date of birth, or other unique identifier must be printed on the specimen label or slides, including specimen type for nongynecological specimens. The following information must be included on the test request form for accurate specimen preparation, interpretation, result reporting, record keeping, and billing. Exclusion of any information may result in specimen rejection and/or processing delays.

  • Patient’s first and last name and other client-specific unique patient identification numbers, such date of birth and sex.
  • Date specimen was collected.
  • Specimen type: Check the space next to the specimen type (e.g., cervical - vaginal smear, gastric brush, bronchial wash, etc.).
  • Complete patient history. For gynecologic specimens, document the following information on the test request form in the upper left corner under the REQUIRED GYN CLINICAL INFORMATION header:
    • Menstrual history: postmenopausal or last menstrual period (LMP), pregnancy history, hormonal therapy, clinical findings such as abnormal bleeding or discharge, IUD use, and previous procedures such as biopsy or cryotherapy.
    • Check appropriate box and specify if Pap smear is for “SCREENING PAP TEST” or “DIAGNOSTIC PAP TEST - PATIENT IS HIGH RISK FOR CERVICAL DISEASE.” Listed below are clinical features utilized by ARUP to determine highrisk status. This list includes, but is not limited to, all high-risk features as defined by the Centers for Medicare & Medicaid Services (CMS).
      • History of any of the following ALWAYS qualifies the specimen as high risk, regardless of the time since any pertinent procedure or diagnosis:
        • High-grade squamous intraepithelial lesion (HSIL), carcinoma in situ (CIS), or cervical, endometrial, ovarian, or vulvar malignancy of any type, diagnosed by Pap test or tissue studies.
        • Chemotherapy, radiotherapy, and/or surgical treatment for cervical, endometrial, ovarian, or vulvar malignancy of any type.
        • Cervical biopsy (including LEEP, cone, endocervical curettage), abnormal endometrial biopsy, colposcopy, or cryosurgery.
        • Unspecified abnormal or atypical Pap test, including inflammatory atypia, with no other information provided (e.g., how long since occurrence).
        • Friable cervix.
        • Pregnancy in patients younger than 18 years of age.
        • All tests on patients 16 years of age and younger.
        • Abnormal bleeding at any age.
        • Any bleeding in a postmenopausal female.
        • D & C in a postmenopausal female.
        • Previous or current sexually transmitted disease, including genital herpes, HPV, and HIV infection.
        • Question of previous abnormal Pap test or biopsy.
        • DES exposure.
        • History of early onset of sexual activity (i.e., before 16 years of age).
        • Multiple sexual partners (five or more in a lifetime).
        • Fewer than three negative Pap tests within the previous seven years.
      • History of any of the following WITHIN FIVE YEARS PRIOR TO THE CURRENT PAP TEST qualifies the specimen as high risk:
        • Low-grade squamous intraepithelial lesion (LSIL) or atypical squamous or glandular cells.
        • Any previous unspecified abnormal or atypical Pap test.
      • History of any of the following does NOT qualify the Pap test as high risk:
        • Unspecified previous abnormal or atypical Pap test greater than five years prior to the current Pap test.
        • AS/GUS or LSIL greater than five years prior to the current Pap test.
        • Carcinoma not primary to the female genital tract, unless metastatic to the female genital tract.
        • D & C in a premenopausal female.
    • For nongynecologic specimens, document the clinical information on the test request form under the NON-GYN CLINICAL HISTORY header:
      • Any pertinent clinical information related to the specimen collected.
  • Name of the referring physician: Clearly state the name of the referring physician and how that individual may be contacted if additional information is required or results need to be reported by phone.

Specimen Rejection

Specimens to which the following conditions apply will be rejected and returned to the originating site.

  • Specimen is submitted without a test request form.
  • Specimen is not labeled with the patient’s full name, date of birth, or other unique identifier (for slides, the frosted end must be labeled with the patient’s first and last name and date of birth in pencil).
  • The patient name (or other identifying information) on the specimen and test request form do not correspond.
  • Specimen labeled appropriately, but the test request form is not labeled.
  • Specimen and/or slide(s) is (are) irreparably broken or damaged.
  • Specimen submitted in expired reagent (SurePath® Preservative Fluid, PreservCyt® Solution, Saccomanno fixative, etc.).
  • Specimen submitted from an unauthorized source.
  • SurePath® tests submitted without the collection devices.
  • Specimen submitted frozen (except Bladder Tumor Associated Antigen Testing) or on a swab.
  • No source or test marked on the test request form.
  • Incorrect specimen submitted for test requested.

Specimens to which the following conditions apply will be discarded:

  • Unlabeled gynecological specimens.
  • Incorrectly labeled gynecological specimens.

Cytology Specimen Adequacy

The adequacy of Pap test collection is determined by:

  • Accurate patient and specimen identification.
  • Pertinent clinical history.
  • Presence of an adequate squamous component.
  • Presence of an adequate endocervical component (in premenopausal females with a cervix).
  • Absence of obscuring entities, including inflammation, blood, and contaminants such as talc or lubricant.
  • Adequate cellular preservation.

Adequacy of nongynecological specimen collection is determined by:

  • Accurate patient and specimen identification.
  • Pertinent clinical history.
  • The presence of adequate site-specific cellular material and/or diagnostic cellular material.
  • Adequate cellular preservation.

Result Reporting

Pap Tests
Please note that the Pap test is a screening test for cervical cancer and its precursors with an inherent false-negative rate.

Turnaround Time
For turnaround time information, refer to the individual test.

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