Regional Laboratory
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The Pap Smear (PS) is a screening test used to detect malignant and pre malignant tumors of the uterine cervix. While no screening test is perfect, the pap smear has significantly reduced the incidence and mortality of cervical cancer in the United States. “Accordingly, a few women will develop cervical cancer despite strict adherence to accepted screening protocols.1”
Approximately 50 million pap smears (PS) are performed annually in the United States with approximately 2.5 million women having low grade squamous intra-epithelial lesions (LGSIL). A survey by Kurman, et al. found that a 5% rate of LGSIL can be found in a general screening population. This has an approximate annual cost of care for these patients of six billion dollars. Approximately, 60% of these lesions will regress spontaneously. In 1988 the National Cancer Institute sponsored a workshop in Bethesda, Maryland which recommended a new low grade/high grade approach for grading dysplastic lesions of the uterine cervix. Guidelines were not given for patient management at the original Bethesda conference but were later addressed in a follow-up meeting in January 1992. That follow-up, Bethesda Working Group’s recommendations for management were published in 1994. These RLA recommendations have been adapted from the guidelines from the second NIH/Bethesda Conference. The following represent guiding principles in the formulation of these RLA recommendations:
1. The highest priority is the best care possible for each individual patient.
2. Systematic evaluation of atypical findings (taking into account the uniqueness of each patient) is cost effective patient care.
3. ASCUS and low grade SIL lesions have a high regression rate (60%) and can potentially be watched in low risk and reliable patients.
4. All high grade SIL lesions must be aggressively and thoroughly evaluated.
References:
1 Kurman RJ, Henson DE, Herbst AL, Noller KL, Schiffman MH: Interim Guidelines for Management of Abnormal Cervical Cytology. JAMA, 271:23,p.1869,1994
2 Cervical Cytology: Evaluation and Management of Abnormalities. ACOG Technical Bulletin, Number 183-August 1993
Spencer W. Kerley, M.D.
Dr. Kerley graduated from the University of Kansas School of Medicine in 1986 where he also completed his internship and residency. This was followed by a fellowship in surgical pathology with the Mayo Clinic in Rochester, Minnesota with a special emphasis on gynecologic and genitourinary pathology. Following completion of training, Dr. Kerley joined Physicians Reference Laboratory where he is currently Vice-Chairman and Director of Anatomic and Molecular Pathology at Saint Joseph Health Center. Dr. Kerley is board certified in anatomic and clinical pathology.
Sioe T. Kwee, M.D.
Dr. Kwee received her medical degree from Indiana University Medical School and completed her pathology residency at Menorah Hospital and the University of Kansas Medical Center. She worked at Providence Medical Center in Kansas City, Kansas beginning in 1971 and joined Physicians Reference Laboratory in May of 1994. She became board certified by the American Board of Pathology in Cytopathology in 1989. Dr. Kwee is a fellow of the College of American Pathologists and a member of the American Medical Association, American Society of Clinical Pathology, and the American Society of Cytopathology.
Patrick Leoni, M.D.
Following graduation from Creighton University School of Medicine in Omaha, Dr. Leoni completed a rotating clinical internship in the United Stated Navy and served four years as a general medical officer and flight surgeon. After the Navy and a year as an urgent care center physician, he was a resident in anatomic and clinical pathology at the Kaiser Permanente Medical Center in San Francisco for two years and at Creighton University for two years. This was followed by a one year surgical pathology and cytopathology fellowship at the University of Kansas Medical Center. Dr. Leoni has been a staff pathologist and medical director of the hematology laboratory at Shawnee Mission Medical Center for the last three years. He has a continuing interest in cytopathology in general and fine needle aspiration cytology in particular.
Michael C. Morgan, M.D.
After attending medical school at the University of Kansas Medical Center, Dr. Morgan completed his residency in pathology at the Institute of Pathology, Case Western Reserve University in Cleveland, Ohio. He then returned to the University of Kansas Medical Center for a fellowship in surgical pathology and cytology. Currently he serves as the Medical Director of Cytology for Saint Luke’s Regional Laboratories.
Laurance W. Price, M.D.
Dr. Price is a graduate of the University of Kansas Medical Center and received pathology training at the University of Oregon and Tripler Army Medical Center in Hawaii. He has served as a U.S. Army pathologist at Walter Reed Hospital and the 406th Medical Laboratory in Japan and at Topeka and Lawrence Hospitals in Kansas. Currently he is an associate pathologist at Lawrence Memorial Hospital. His particular cytology interest is the interpretation of fine needle aspirations.
James Quigley, M.D.
Dr. James Quigley is a graduate of the University of Missouri School of Medicine, Columbia. He did his pathology training at Ohio State University and the University of Michigan. He has been in practice for fifteen years. Dr. Quigley came to Shawnee Mission Medical Center in 1984 and has recently become Laboratory Medical Director. Special interests include cytopathology, transfusion services, and risk management.
Keith A. Richards, M.D.
After graduating with a Bachelor of Arts in Biology, Dr. Richards received his Doctor of Medicine degree from the University of Virginia School of Medicine. He was Chief Resident in Pathology during his internship/residency in anatomic and clinical pathology at the University of Rochester in New York. He then served a fellowship as co-director of the Immunocytochemistry Laboratory at that University. Dr. Richards previously was an associate pathologist and Assistant Director of Clinical Laboratories at Olean General Hospital and St. Francis Hospital in New York. He is boarded in anatomic, clinical and cytopathology and has special interest in cytology, surgical pathology and immunocytochemistry. He is currently the Director of the Cytology Department for MAWD Pathology Group where he has been a staff pathologist for five years.
Philip Van Thullenar, M.D.
Dr. Van Thullenar received his M.D. from St. Louis University and completed a pathology residency at the old Kansas City General Hospital. He spent two years in the Air Force running the laboratory at MacDill AFT in Tampa and doing aircraft accident investigation. He developed an early interest in cytology and studied with a number of prominent investigators such as George Wied, Leopold Koss, James Ragan, Lorna Johnson and John Frost. Following a seminar on aspiration cytology with Bernard Naulor, he started the aspiration cytology program at St. Luke’s Hospital in 1972. He currently practices at Bethany Medical Center.
Angela A. Villanueva, M.D.
Dr. Villanueva received her medical degree from the University of the Philippines, Manila, and completed her post-graduate studies in pathology at the University of the Philippines and the University of Kansas Medical Center. She was appointed a Fellow/Instructor in Pathology at Truman Medical Center in 1970 and then served as Clinical Assistant Professor of Pathology at KUMC. She has been an associate pathologist at Physicians Reference Laboratory since 1976. Dr. Villanueva serves as Co-Director of Cytopathology at PRL. Her special interests are surgical pathology and cytopathology, including fine needle aspiration.