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The Department of Pathology at OUHSC has developed a focus over the years on diseases in women. We believe that pathology in women requires specialization and accordingly we have brought together the resources and faculty required to provide a superb suite of women's services. These are described below:
Pap Smears and Cervical Biopsy Service
The Cytopathology Laboratory offers one of the finest programs available for cervical cancer screening. Our cervical screening features a new Bethesda electronic reporting system with auto faxing of results to clients. Our fine staff of highly trained pathologists and cytotechnologists have focused on quality and correlation of patient history and cervical biopsy information. With summary reports to clients for follow-up studies, the system is designed to detect and alert physicians by phone and auto fax when abnormal results are obtained on patients.
The recent addition of our Thin Prep Pap service has enhanced sampling and minimized sampling errors commonly seen with some Pap screening programs. This test has been hailed as the most exciting innovation in cervical cytology since the introduction of the Pap smear. It has been approved by the Federal Drug Administration (FDA) as an alternative to traditional Pap smear. The test is associated with improved specimen quality, more efficient detection of squamous lesions of the cervix, and reduction in the number of "unsatisfactory" and "satisfactory but limited" interpretations and thus, is significantly more effective than the standard smear. While the process of taking the cervical sample for the Thin Prep Pap is identical to that for the routine smear, the sample device is placed into a fluid medium rather than spread on a glass slide. This fluid preserves the cells until the sample is received in the laboratory where a relatively uniform layer of cells is cast onto a glass microscope slide and stained with the Papanicolaou stain. A report is generated within 48 hours of receipt in the laboratory and faxed to the ordering physician. An additional benefit to the Thin Prep Pap test is that the same fluid-based specimen can be used for Human Papilloma Virus (HPV) Hybrid Capture testing in the Molecular Pathology Laboratory.
Endometrial and Laparoscopic Biopsies
Our laboratory also offers expert interpretation of endometrial and laparoscopic biopsies in addition to the full range of gynecologic specimens.
Human Papilloma Virus
Human papilloma virus (HPV) infection is the most common sexually transmitted viral disease. More than 70 HPV genotypes have been identified, of which more than 30 are associated with lesions of the ano-genital mucosa, including condyloma, Bowenoid papulosis, cervical, vaginal, and vulvar intraepithelial neoplasia and carcinoma. Although many HPV-related lesions appear to regress, others persist and may progress to an invasive neoplasm. HPV types16,18,31,33,35,39,45,51,52,56,58,59, and 68 have been generally regarded as being associated with a high-risk for development of cervical cancer, while types 6,11,42,43, and 44 have a low-risk association with cancer.
HPV infection has been demonstrated in 85% of invasive squamous cell carcinomas and pre-malignant lesions. The virus is also present in approximately 10% of women with apparently normal cervical epithelium by cytology; the actual prevalence of HPV in specific groups of women is strongly influenced by age and other demographic variables. Prospective studies have shown that 15-28% of HPV-positive women develop squamous intraepithelial neoplasia within 2 years, compared to only 1-3% of HPV-negative women.
The Molecular Pathology Laboratory offers the Digene Hybrid Capture Microplate HPV Assaywhich has recently been FDA-approved for clinical diagnosis. This test serves as an adjunct to the Pap smear or Thin Prep Pap Test in the identification of women who may be at increased risk for SIL and in addition, aids in the triage of patients with equivocal or ASCUS results by cytology. The Hybrid Capture Microplate HPV Assay is able to detect 13 high/moderate-risk HPV types 16,18,31,33,35,39,45,51,52,56,58,59, and 68 in either a fresh cervical swab, fresh biopsy, or fixed Thin Prep cells. Referring physicians/laboratories requesting this test will receive a written report within 1 week of receipt of the specimen.
Placenta Screening Program
Three of our pathologists have considerable experience in placental evaluations and are experts in identifying relations between pathology findings on placenta examinations and the status of the associated fetus and newborn.
Ed Kelsay states in the Oklahoma State Medical Association's publication entitled "Patient Relations as a Loss Prevention Tool" (1991), that over $1,000,000 is paid each year in Oklahoma for alleged fetal damage attributed to physician malfeasance. However, pathological studies of placentas from hypoxic newborns and premature babies have shown that 90% of these specimens have placental pathology.
State medical associations and health care providers have recommended that all placentas be held for one week at 4°C. This guarantees availability of a gross and light microscopic pathology report should the clinical need arise. The Oklahoma State Association of Pathologists strongly endorses a quality assurance protocol for examination of placentas. We believe our staff is very well-qualified to accomplish this goal. The College of American Pathologists and the Physicians Liability Insurance Company (PLICO) have encouraged physicians who care for expectant mothers and newborns to examine the placenta based on the following criteria:
- Maternal illness during pregnancy - hypertension, immunization, diabetes, viral infections (herpes, CMV, HIV, etc)
- Prematurity (32 weeks or less)
- Previous stillbirth or premature births, or multiple miscarriages
- Post-maturity (pregnancy longer than 42 weeks)
- Maternal substance abuse
- Oligo or polyhydramnios
- Congenital anomalies
- Low Apgar scores
- Meconium staining
- Fetal distress
- Caesarean section due to fetal indications
- Infection (bacterial or viral)
- Small or large for gestational age
- Fout smelt of the placenta
- Multiple births
- Stillbirth at 20 weeks or over or perinatal death
- Micro crania or hydrocephatus
- Maternal hypertension
- Erythroblastosis or hydrops
- Premature rupture of membranes
- Low fetal weight
- Abruptio placentae
- Large infarcts
- Ruptured vasa previa
- Chorangioma or unexplained mass
- Abnormal appearing or knotted umbilical cord
- Newborn admitted to a neonatal intensive care unit
- Miscellaneous abnormalities of concern to the clinician
Recommended Triage and Delivery of the Placenta:
- Placentas may be sent fresh if refrigerated immediately at 4°C or transported fixed in formalin.
- A fresh placenta should not be sent unless the total transport time is less than four (4) hours
- Formalin-fixed placentas should be placed in formalin with membranes and umbilical cord intact. We strongly recommend that the initial ratio of formalin/specimen be 7:1 by volume.
- Label the container with a black marker with the patient's name, institutional number, delivery date, hospital or institution name and phone number.
- Prepare and attach the paperwork including:
- Institution name and phone number
- Patient's name
- Physician's name, phone, and fax numbers
- Delivery date and date placenta was sent to OU Pathology Laboratories
- Reason for placental examination
- Complete description of clinical history and delivery including:
- Fetal age in weeks gestation
- Fetal weight
- Clinically relevant ante-partum, intra-partum, and postpartum information
Triple Marker Service
Our Pathology Laboratory offers a Triple Marker Service for screening material serum and identifying those pregnancies at risk for Down Syndrome (DS) and neural tube defects (NTD). The testing is based on maternal serum levels of alpha feto protein (AFP), unconjugated estriol (uE3), and human chorionic gonadotrophin (HCG). These three markers are combined by an expert computer program to predict the risk of DS and NTD. The service provides a complete consultative report with follow-up reports available as required when corrections to gestational age are made.
A complete panel of fertility tests are available with testing for gonadotrophins, including FSH, LH, and HCG along with testing of target organ production of estradiol and progesterone. Our new estradiol test is highly specific and precise, especially in lower serum levels Where precision has been shown to be a problem with some assays. In addition, prolactin testing is available along with androgen testing including both testosterone and DHEA sulfate. The HCG assay is available on an emergency basis to screen for ectopic pregnancies.
Serum tumor markers performed routinely include CA125 for ovarian cancer, CEA for colorectal cancer, HCG testing for trophoblastic malignancies, and AFP for cancers of the liver. Estrogen and progesterone receptors are also available for breast malignancies with reporting collated on the surgical pathology report. Several new breast tumor markers are under investigation as well.
Screening for Bone Disease
New tests for screening women for bone loss include deoxypyridinoline, a marker which identifies those women at risk for bone loss. This test is especially useful for post-menopausal females trying to decide whether to take hormone replacement therapy (HRT), in part to prevent bone loss. The test is performed on urine and reported as a ratio with creatinine. Other esoteric tests for bone loss assessment include intact parathyroid hormone testing, PTH, by chemiluminescence plus estradiol and progesterone testing to monitor HRT therapy.
Testing capability for anemia in females includes our highly automated hematology and chemistry laboratories together with immunoassays for ferritin to assess iron stores and B12 and folate for identifying megaloblastic anemia. Further evaluation of anemia is provided by our bone marrow aspirate and biopsy services in anatomic pathology.
The UPMG laboratory offers a complete thyroid screening panel including TSH and free-T4 testing. We also offer active renin for hypertension screening and insulin and HbA1C testing for diabetes.
New cardiac markers for diagnosing acute myocardial infarction include heart muscle specific troponin-I along with myoglobin. The CK-MB mass test is also available. All of these markers are available on an emergency basis.
Neonatal screening includes our hepatitis B screen. A positive result on maternal serum results in a consultative report with specific recommendation on how to handle the mother and child.
Procedures available in our state-of-the art microbiology section include RPR, Herpes, GC/Chlamydia by DNA probes, Rubella, Strep group B, urine cultures, and many other tests. We also offer a full virology laboratory, the only lab of its kind in the region.
Benefits of Services
- Services are competitively priced.
- Consultations are included when appropriate to assist in interpretation.
- Emergency services are available when needed.
- Our Pathology Laboratories are here to serve you. Our mission continues to be excellent patient care, teaching, and medical research.
For additional information:
Pap Smears and Cervical Biopsy Service:
Rosemary E. Zuna, MD
Director of Cytopathology
Telephone (405) 271-5507; FAX (405) 271-6573
Human papilloma virus:
S. Terence Dunn, Ph.D.
Director, Molecular Pathology Laboratory
Telephone (405) 271-5249; FAX (405) 271-2568
Kenneth E. Blick, Ph.D.
Telephone (405) 271-7632; FAX (405) 271-3620