Q. What is the CAP-accepted turnaround time for Pap tests?
A. Currently, the CAP checklist has no requirement regarding turnaround time for Pap tests. That’s because the Pap test is a screening test, and there is variability in staffing with frequent shortages of cytotechnologists. An artificial turnaround time limit would encourage laboratories to force cytotechnologists to screen faster and thus increase errors. The quality and accuracy of screenings are more important than speed of reporting. Hence, Pap tests should be signed out in a timely manner, one that is appropriate for patients' clinical management. Certain specimens from high-risk patients, as well as those with pending biopsies or surgery, can be expedited for screening purposes in a given laboratory, if that information is available.
The issue of turnaround times in gynecologic cytology was the subject of a CAP Q-Probes study published in 1999.1 According to the study, the turnaround time varied, depending on characteristics of the laboratory, the location where the screening is performed, whether ancillary testing or instrument rescreening is performed, and whether there is a cytotechnology or residency/fellowship program affiliated with the laboratory. Based on this report, turnaround times are significantly longer when residents, fellows, or cytotechnology students were involved in screening or physician contact was necessary to obtain additional information. The use of reference laboratories also contributed to longer turnaround times.
The median turnaround time from specimen collection to final report sign-out was six days, with the 10th and 90th percentiles being 13.6 and 2.7 days, respectively. The median turnaround time from receipt in laboratory to final report sign-out was 4.4 days, with 11.7 and 1.4 days constituting the 10th and 90th percentiles. The mean turnaround times for different laboratory types are also given in this report.1
The issue of turnaround time of Pap tests also was discussed at an International Consensus Conference on Fight Against Cervical Cancer in March 2000. This conference was sponsored by the IAC along with several national and international organizations, including the CAP.
Task force No. 14, which dealt with quality assurance and risk reduction guidelines specifically, addressed this issue. The international panelists on this task force did not agree on turnaround time. The panelists from the United States firmly believed there was no need for an artificial time limit on a screening test as long as the test was performed in a timely manner. The international panelists, especially the Italians, said that perhaps four to six weeks would be more appropriate. The Australians, on the other hand, have a mandated turnaround time of approximately five working days. Obviously, there is no consensus as to whether there should be an artificial turnaround time limit for Pap tests, as long as it is performed thoroughly, accurately, and in a timely manner.2,3 What is timely depends on your patient population and should be decided by the individual laboratory.
Currently, CLIA '88 does not stipulate a turnaround time limit on Pap tests. Perhaps this is a wise decision, as cytotechnologist shortages vary from region to region. It would be difficult to implement an across-the-board turnaround time for this valuable screening test without negatively affecting the health of the population.
1. Jones BA, Valenstein PN, Steindel SJ. Arch Pathol Lab Med. 1999;123:682-686.
2. Mody DR, Davey DD. Acta Cytol. 2000;44(4):496-507.
3. Yu GH, Gupta PK. The pathological obsession with turnaround time in gynecologic cytology: Is it warranted? Diagn Cytopathol. 1998;19:321-322.
Dina R. Mody, MD
Department of Pathology
Baylor College of Medicine
CAP Cytopathology Committee
Q. Are there any recommendations about reporting sperm on a microscopic urine examination? Some of our technologists have been trained to not report them, and some report them only on men.
A. The presence of sperm in urine (spermaturia) is a common phenomenon. One study found sperm in 84.8 percent of postejaculatory urine specimens in adult men.1 A study of boys age 10 to 17 years analyzed consecutive morning urine samples over a 10-day period and found 13 percent of the samples showed spermaturia.2 Other investigators have suggested that analysis for spermaturia using daily specimens could be useful in evaluating gonadal maturation.3 Sperm can also be observed in the urine of females following intercourse, although this phenomenon has not been as well studied and quantified.
Based on these findings, it is easy to see why some would argue that spermaturia is a normal phenomenon and hence does not need to be reported in a routine urinalysis. This position assumes that an individual alleging rape or being tested for the efficacy of a vasectomy or retrograde ejaculation will have more specific and appropriate testing performed, and this is probably a reasonable assumption. However, it is important to have procedures in place that lead to appropriate notification if sperm are observed in urine where such a finding would clearly not be considered normal.
Any case in which sperm is observed in the urine of a child, male or female, younger than 10 years requires further action. A reasonable approach to such an observation includes:
- confirmation of the presence of sperm by another qualified observer;
- review of the handling of the specimen to ensure as much as possible that there has been no specimen mix-up; and
- reporting directly to the ordering physician that sperm has been observed in the child's urine.
When spermaturia is identified in children younger than 10, it suggests several abnormal conditions that should be addressed. It raises the possibility of abnormal sexual maturation in males, and it raises the possibility of sexual abuse in females.
Some physicians caring for adolescents find the reporting of spermaturia of value in caring for their patients (e.g. discussions of protection from sexually transmitted disease and unwanted pregnancy) and might be consulted about their feelings about reporting of sperm in urinalysis.
Another circumstance where spermaturia needs to be further investigated is in cognitively impaired women in a nursing home setting, where once again spermaturia may be indicative of abuse. In this context, recognition of the need for reporting by the laboratory is much less clear (i.e. there is no age cutoff) and needs to be discussed with physicians responsible for such patients.
1. Weissenberg R, Rozenman H, Hova M, et al. The diagnostic value of sperm in post-ejaculatory urine. Int J Andrology. 1984;7:142-148.
2. Kulin HE, Frontera MA, Demers LM, et al. The onset of sperm production in pubertal boys. Am J Dis Child. 1989;143:190-193.
3. Schaefer F, Marr J, Seidel C, et al. Assessment of gonadal maturation by evaluation of spermaturia. Arch Dis Child. 1990;65:1205-1207.
Robert Novak, MD
Department of Pathology
Medical Center of Akron
Hematology and Clinical
Microscopy Resource Committee