Bare Bones: Inside the HPV and LBC Laboratory

Where Laboratories Lose the Most Time After the Transition Away from Conventional CytologyWhere Laboratories Lose the Most Time After the Transition Away from Conventional Cytology

On June 1, 2026, reimbursement for conventional cervical cytology within Poland’s national cervical cancer screening program officially came to an end. It marks a symbolic turning point for the entire diagnostic community. After years of relying on traditional smear-based cytology, the focus is shifting toward liquid-based cytology (LBC), HPV testing, and the increasingly widespread use of molecular diagnostics.

For laboratories, this transition means far more than simply adopting a new technology. It requires a fundamental reassessment of workflow design, resource allocation, and operational efficiency. New systems, automation, and the integration of multiple diagnostic methods from a single specimen have become central topics of discussion.

At the same time, it is important to recognize that most laboratories are not processing thousands of samples every month. Many facilities perform only 20–30 tests per week, approximately 200 per month, or a few thousand annually. This reality is very different from the high-throughput scenarios commonly featured in manufacturers’ brochures and marketing materials.

And this is where an important question arises—one that is still asked far too rarely during discussions about laboratory modernization:

Does a laboratory truly need an instrument designed to process 48, 96, or even several hundred samples per day?

Many laboratories invest in large-scale solutions because they want to remain competitive, offer HPV and LBC testing, and keep pace with changes in the market. That is entirely understandable. The challenge appears when the cost of the technology begins to consume a significant portion of reimbursement revenue while laboratory personnel continue to perform much of the workflow manually.

Modernization should not simply mean purchasing the most widely adopted system on the market. It should mean selecting a solution that is genuinely aligned with the laboratory’s actual workload, operational requirements, and long-term development strategy.

Technology Is Only Part of the Process

Manufacturers of LBC systems tend to focus primarily on technical specifications, including:

• the number of slides processed per hour,

• the level of automation,

• integration with laboratory information systems,

• continuous processing capacity.

These are important parameters. However, for a laboratory performing 20–30 tests per week, they are not always the most relevant ones.

If a laboratory processes only a few dozen samples per week, the key question is not:

“How many samples can the instrument process per hour?”

More important questions include:

• How much time does laboratory staff spend preparing samples?

• What is the true cost per test?

• Can both HPV testing and cytology be performed from the same specimen?

• How much hands-on work does the system require?

• Can the laboratory expand its diagnostic capabilities without increasing staffing levels?

For small and medium-sized laboratories, a system that saves two hours of staff time per week may provide far greater value than an instrument capable of processing 500 samples per day. Equally important is whether growth can be achieved without hiring additional personnel or placing extra pressure on the existing team.

Even more importantly, many laboratories consider changing technologies simply because a particular platform is perceived as more popular, more established, or more modern. Yet in some cases, the only thing that changes is the name displayed on the instrument.

The underlying technology remains essentially the same. The workflow remains the same. The manual workload remains the same.

From an operational perspective, very little actually changes.

In some situations, this may even be viewed as an advantage. Laboratory staff are rarely enthusiastic about learning entirely new workflows, and minimizing disruption can have its benefits. However, laboratories should carefully consider whether a technology transition delivers genuine improvements in efficiency, automation, or diagnostic capability—or whether it simply increases the cost per test while maintaining the same operational model.

Modernization should not be measured by the logo on the instrument. It should be measured by measurable improvements in workflow, efficiency, cost-effectiveness, and diagnostic performance.

One Specimen, Multiple Tests – The New Diagnostic Reality

One of the most significant changes in recent years is that an LBC sample is no longer used exclusively for cytological evaluation.

Increasingly, the same vial serves as the source material for:

• high-risk HPV testing,

• cytology,

• additional molecular analyses,

• emerging molecular and screening algorithms.

This represents a major organizational shift.

Only a few years ago, laboratories focused primarily on preparing a cytology slide. Today, a single sample can provide information for multiple diagnostic pathways.

As a result, solutions that allow both HPV testing and cytology to be performed from a single specimen without additional preparation steps are becoming increasingly valuable.

The fewer manipulations required, the less staff time is consumed, the lower the risk of errors, and the lower the overall cost of the process.

Pre-Analytical Phase – The Often Overlooked Stage

Before any sample reaches the analytical phase, it passes through a series of preparatory steps.

These typically include:

• sample accessioning,

• patient data verification,

• documentation review,

• sample sorting,

• preparation for downstream processing.

Large laboratories often focus on instrument throughput. Smaller laboratories frequently face a different challenge: the amount of time spent preparing a relatively small number of samples.

If a technician spends three hours per week preparing 20–30 HPV or cytology samples, it is worth asking a simple question:

Is all of that time truly necessary?

Today, there are solutions capable of automating a substantial portion of these activities and reducing preparation time from several hours to approximately one hour.

In practical terms, this means recovering valuable staff time that can be redirected toward other diagnostic responsibilities, quality assurance activities, or future service expansion.

Opening Vials and Pipetting – Small Tasks, Big Impact

One of the most underestimated aspects of day-to-day work in an LBC laboratory is the accumulation of repetitive manual tasks.

Opening and closing vials, mixing samples, and pipetting may seem straightforward. However, these activities often consume a significant portion of the time required to prepare small batches of specimens.

Paradoxically, many laboratories invest in advanced diagnostic platforms while continuing to perform most preparatory steps manually.

As a result, the laboratory pays for modern technology without fully benefiting from automation.

Perhaps the most concerning aspect is that some of these solutions are marketed as “fully automated,” despite the fact that a substantial proportion of the workflow still depends on manual intervention.

Meanwhile, there are systems capable of automatically:

• preparing samples for HPV testing,

• dispensing specimens,

• reducing or eliminating manual pipetting steps,

• significantly decreasing technician hands-on time.

For a laboratory processing 20–30 tests per week, the difference between three hours and one hour of preparation time may be far more valuable than maximum instrument throughput.

Laboratory Layout Matters

Many laboratories have evolved gradually over years or even decades. As a result, different stages of the workflow are often performed in separate rooms or at physically distant workstations.

A typical workflow may involve:

• sample accessioning in one location,

• specimen preparation in another,

• the LBC instrument in a separate room,

• staining and downstream processing elsewhere.

Each individual movement takes only a small amount of time. However, when staffing resources are limited, even minor inefficiencies can accumulate into a meaningful operational burden.

A well-designed laboratory layout reduces unnecessary specimen movement, improves communication between workflow stages, and helps staff work more efficiently.

At the same time, workflow optimization involves much more than workstation placement alone.

In some laboratories, the true bottleneck may indeed be instrument capacity, making investment in a higher-throughput platform entirely justified. In others, greater gains may be achieved by simplifying workflows, reducing manual steps, or consolidating multiple processes within a single solution.

For this reason, technology decisions should be driven by the laboratory’s actual operational requirements rather than by specifications alone.

A particularly interesting example is DASA in São Paulo, one of the largest diagnostic laboratory networks in South America. The organization performs approximately 60,000 LBC tests per month and hundreds of thousands of HPV tests annually. Over the years, DASA evaluated multiple workflow models, including some of the most widely adopted high-throughput solutions available globally. Ultimately, however, it adopted a workflow based on low-throughput, single-specimen processing systems rather than large batch-processing platforms.

The experience of laboratories such as DASA demonstrates that productivity is not determined solely by the number of samples processed per hour. Equally important factors include:

• total process cost,

• the number of manual handling steps,

• workplace ergonomics,

• specimen logistics,

• staff utilization.

In practice, a well-designed workflow can often deliver greater operational benefits than simply replacing an instrument with a larger one.

This is a particularly interesting observation because many significantly smaller laboratories assume that effective HPV and LBC testing requires very high-throughput solutions. Yet the experience of some of the world's largest diagnostic organizations suggests that workflow design and process efficiency can be just as important as the technology itself.

Lack of Standardization – The Laboratory’s Invisible Cost

One of the most frequently overlooked aspects of laboratory operations is the lack of standardization between workstations and personnel.

In many laboratories, differences may exist in:

• the sequence of workflow steps,

• sample preparation procedures,

• workstation organization,

• placement of consumables and supplies,

• documentation practices.

Experienced staff members often develop highly effective personal workflows over time. However, as HPV testing and molecular diagnostics continue to expand, process consistency becomes increasingly important.

Standardization helps maintain quality, reduce errors, improve training efficiency, and make better use of personnel resources.

More importantly, it allows laboratories to scale operations without becoming dependent on the habits and experience of individual employees.

A well-designed process should deliver the same outcome regardless of who performs it.

Ergonomics – More Important Than It Seems

When planning a laboratory, significant attention is usually given to instrumentation and analytical performance. Far less attention is paid to workstation ergonomics.

Yet ergonomics has a direct impact on both staff well-being and operational efficiency.

Repetitive activities performed for hours each day can contribute to:

• wrist strain,

• shoulder pain,

• back problems,

• increased fatigue.

Many laboratories are implementing HPV testing without increasing staffing levels. As a result, additional responsibilities are often assigned to personnel who are already managing existing workloads.

For this reason, technology selection should consider not only diagnostic performance but also its impact on everyday laboratory operations.

If pre-analytical processing consumes more time than the automated analytical phase itself, it becomes difficult to argue that the workflow has truly been optimized.

In such situations, laboratories should ask whether a new technology genuinely supports growth or simply adds more tasks to an already overloaded team.

If increasing headcount is not part of the plan, the ideal solution should integrate into existing workflows with minimal disruption while reducing the number of manual handling steps wherever possible.

The best technology is not necessarily the most complex or the most expensive—it is the one that expands diagnostic capabilities without adding additional hours of work for laboratory personnel.

Does the Laboratory Know the True Cost of a Test?

Most laboratories have a clear understanding of their direct costs, including:

• collection vials,

• reagents,

• instrument leasing or rental agreements,

• HPV test kits.

What is often overlooked, however, is the cost of lost time.

For a laboratory performing approximately 200 tests per month, investing in a solution designed for volumes many times greater may not always represent the most rational business decision.

Instead, laboratories should ask themselves a few important questions:

• What proportion of reimbursement revenue is allocated to the technology provider?

• How much staff time is required to prepare each sample?

• Is there a more cost-effective alternative with comparable or even superior diagnostic performance?

• Can the number of manual workflow steps be reduced?

• Can both HPV testing and cytology be performed from a single specimen without additional preparation stages?

Modern diagnostics does not necessarily mean higher costs.

In many cases, it simply means selecting a technology that is better aligned with the laboratory’s actual workload, staffing model, and long-term operational goals.

Conclusion

The end of reimbursement for conventional cytology marks more than a regulatory change. It represents the beginning of a new era for laboratories involved in cervical cancer screening and diagnostics.

An LBC specimen is no longer used solely for cytological evaluation. Increasingly, it serves as the source material for HPV testing and a growing range of molecular analyses.

At the same time, most laboratories do not require solutions designed for the largest diagnostic centers. What they need is technology that enables faster testing, lower operational costs, and reduced workload for laboratory personnel.

For this reason, laboratories should look beyond brand recognition, instrument size, or maximum throughput specifications. More important questions involve the total cost of the process, the level of automation, the ability to perform multiple tests from a single specimen, and the actual time savings achieved in routine practice.

When an HPV and LBC laboratory is examined from a workflow perspective, it quickly becomes clear that the greatest competitive advantage is not always the largest instrument or the highest throughput.

Sometimes, the real advantage lies in a solution that delivers the same diagnostic objectives with higher sensitivity, lower overall cost, and without placing additional demands on an already stretched laboratory team.

Ultimately, successful laboratory modernization is not about adopting the most impressive technology. It is about choosing the technology that best supports the laboratory’s workflow, staff, patients, and long-term sustainability.