Obstetricians & Gynecologists


Aurora Diagnostics GPA Laboratories provides the highest quality, customized gynecological services.

Trust
• Expert, board-certified cytopathologists
• Accurate diagnoses
• Consistent reporting among pathologists
• Participation in the CAP quality assurance program
• Correlation of Pap test and biopsy results
• Additional review on all malignancies
• Over 54 years of experience providing quality pathology services

Innovation
• ConnectDx connectivity solutions include:
— Integration with your EMR and PMS
— Intelligent data delivery process
— Proactive management of electronic environment
— Customized practice reporting

• Specialized services include:
— Image analysis for cervical cytology
— Genotyping for HPV
— Summary reporting for patients receiving abnormal Pap test results
— A single, integrated cervical cytology and HPV testing laboratory report

Service
• Access to cytopathologists for personal consultations
• 24-48 hours turnaround time on Routine Paps and 3-5 days on Ancillary/Molecular Testing
• Courteous and professional service
• Customized reports
• Daily specimen pick-up
• Knowledgeable field representatives
• Live client services; no automated telephone menus
• Ancillary testing performed from the Pap vial
• Automated patient Pap test result hotline
• Extensive managed care contracts
• Immediate telephone calls to physicians on all high-grade/malignant results

Cytology
With over 50 years of total experience, and accredited by CLIA, the Cytology Laboratory is a full-service laboratory offering Thinprep™ with Imaging and Surepath™ technology to process gynecological samples as well as non-gynecological samples. We offer numerous ancillary testing for women’s healthcare, such as:
• High Risk Human Papilloma Virus (HPV)
• HPV 16/18 Genotyping
• Cervical DNA Dtex
• Chlamydia Trachomatis (CT)
• Neisseria Gonorrhoeae (NG)
• Herpes Simplex Virus (HSV)
• Cystic Fibrosis
• Vaginitis Panel
• Cultures
• Prenatal Screening such as Group B Strep

Our Cytotechnologists are highly skilled healthcare professionals who use a microscope, computer imaging, and molecular diagnostics to examine human cell samples to look for cancer, pre-cancerous lesions, infections, and other diseases. All cytotechnologists are board certified by the American Society of Clinical Pathologists.

Specimen Collection
The use of lubricants should be minimized prior to specimen collection due to increase risk of contaminating the alcohol based transport medium or obscuring the cervical cellular sample. NCCLS guidelines recommend that no lubricant be used during Pap testing but suggests lukewarm water be used to lubricate and warm the speculum. ACOG recommends that care be taken not to contaminate the specimen with lubricant because this may lead to an unsatisfactory result. If a lubricant must be used due to patient discomfort or other circumstances, take care not to contaminate the cervix or collection devices with lubricant. A tiny amount of lubricant may be used, just enough to sparingly coat the speculum, avoiding the tip of the speculum.

Removal of excess mucus, inflammatory exudate, or other discharge before taking the sample is just as important. The excess cervical mucus and exudate is essentially devoid of meaningful cellular material and when present in the sample vial may yield little or no diagnostic material present. It should be gently removed from the cervical canal with forceps and a gauze pad.

The cervix should not be cleaned by washing with saline or it may result in relatively acellular specimen. Also the sample should be obtained before the application of acetic acid. Improper collection techniques such as excess lubricant and mucus, cervical washing, and use of the wrong collection devices, can adversely affect slide presentation. The Pap slide remains a representative of what the clinician has collected and rinsed into the vial.

Specimen Adequacy
Aurora Diagnostics GPA Laboratories uses the most recent Bethesda System guidelines for liquid based cytology result coding. Some of cellular compositions guidelines are:
• The Pap slide must have 5000 well-visualized and preserved squamous cells to be satisfactory for evaluation.
• The presence or absence of an endocervical component should be noted. Ten well-preserved endocervical or squamous   metaplastic cells, singly or in groups, should be observed to report a transformation zone component as present.
• The presence of abnormal cells makes any specimen an adequate specimen.

We understand the challenges faced with receiving unsatisfactory Pap results. Slides with cell clustering, atrophy, cytolysis, blood, inflammation, or scant cellularity can be technically difficult for the laboratory to render a satisfactory Pap evaluation. We confront these challenges by:
• Strict objective criteria and professional judgment applied in every case
• Hierarchical quality control review by senior level cytotechnologist
• Glacial acetic acid mixture reprocessing
• Education to our clients

These value added steps along with communication between the lab and the clinician remains key to our success in maintaining a low unsatisfactory rate when compared to national CAP standards.

Another challenge that clinicians face are satisfactory for evaluation Paps without endocervical transformation zone component. Bethesda 2001 guidelines recommend the presence or absence of endocervical component be reported in all satisfactory Pap specimens. Endocervical component is present if ten or more endocervical or squamous metaplastic cells are identified in a Pap. Medical literature shows as many as 20% of liquid-based paps may lack endocervical component. In our lab, only 3% of overall Paps show lack of endocervical component.

The absence of endocervical component is most often related to collection, patient status and/or screening error. Pregnancy, oral contraceptives and postmenopausal status all make it more difficult to obtain transformation zone component.

There have been numerous studies that showed no significant difference in pap smears with endocervical component and those without endocervical component. The current ASCCP guidelines recommend a Pap follow-up in twelve months for a woman with a negative Pap and no endocervical component. A six-month follow-up may be warranted in some situations (prior atypical Pap, inability to visualize cervix, inability to get adequate sample, immunosuppression, poor patient follow-up).

Specimen Interpretation
To provide you the confidence in your Women’s Health testing our Pathologists and Cytotechnologists are all board certified. They are provided continuing medical education and must undergo routine proficiency testing. Technical skill evaluations are performed to continually monitor personnel to assure that we provide the highest quality possible. Our clients are rest assured that the interpretations provided are accurate and precise to each patient.

One of the most common Pap interpretations that offers insight to a physicians practice, patient population, and laboratory confidence is the ASCUS rate. ASCUS Paps are one of the most common types of abnormal interpretations rates. Its presence indicates mild cellular cervical changes with an unknown cause. A common cause of ASCUS Paps is minor infection and cervical inflammation. Infection and inflammation can cause cervical cells to appear abnormal, but eventually return to a normal appearance. For some women, an ASCUS result is due to changes in the cervical cells caused by HPV infection. In most cases, these cervical changes do not progress to cervical cancer, but require further monitoring and possible treatment to prevent cervical cancer.

ADXGPA monitors its ASCUS and ASC/SIL ratio closely. Providing solid laboratory confidence by interpreting true ASCUS Paps is our strength. This is how we maintain an acceptable ASCUS rate when compared to national guidelines.

Specimen Testing
ADXGPA offers the most current testing in women’s health to its physicians and patients. Our tests are FDA approved &/or validated to provide you confidence of accurate results. These include:
• Liquid based Pap testing with or without Image guided screening
• HR HPV testing
• HPV Genotyping
• Chlamydia testing
• Gonorrhea testing
• Herpes testing
• Cystic Fibrosis
• Vaginitis testing (Trichomonas, Candida, & Vaginosis)

For your convenience and assurance in ordering, many of our ancillary tests are available via our standing order program. Knowing that HPV is reflexed based on certain conditions or Chlamydia/Gonorrhea is routinely ordered based on specific guidelines, has proven to be an added benefit to our clinicians.

Specimen Reporting
Our laboratory offers a variety of different ways you can order laboratory tests as well as receive patient results.
Pap results can be integrated with ancillary results all on one report. Some of our reporting mechanisms include:
• Hard copy (mail or courier)
• Fax copy
• Secure web portal
• EMR interface

An advantage with using ADXGPA is our Televox patient reporting service. This offers peace of mind and easy management of Pap results directly to your patient. Patience may call or access their results via secure website eliminating your office staff to keep track of the process.

ADXGPA can also provide your office with patient abnormal result summaries to assist with patient management follow up. Statistical results feedback is also available to help you and team monitor your adequacy and interpretation compared to others in your group, our laboratory and national data rates.

Summary of services:
• Low percentage of unsatisfactory Pap results
• Second peer review on all Pap initially interpreted as unsatisfactory including treating and reprocessing of Paps where   needed
• Low percentage of Paps without endocervical transformation zone component
• Acceptable ASCUS Pap rates
• Client education, monitoring, and feedback available
• Proven and approved ancillary testing: High Risk HPV testing, HPV 16/18 Genotyping, CT/NG, HSV, CF, and Vaginitis
• Standing order program
• Senior Cytotechnologists
• Greater than 10% quality control (2nd review) on random and high risk patients
• Statistical result data monitoring
• Reporting: Televox, hardcopy, fax, web, and interface
• Integrated Pap and ancillary reporting
• One call phone service without automated attendant
• Remarkable TAT
• Cytology Pap-surgical bx correlation
• Our lab statistical data and correlations are in line with national CAP standards
• QC entry of all ancillary results
• Lab adheres to all strict regulatory standards along with added internal quality control and procedures to assure accurate   results
• Lower screening slide rate per hour than many larger labs

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