FALL 2006

1915 South 17th Street, Suite 100Wilmington, North Carolina 28401 p) 910.362.9511 f) 910.362.9512 www.wilmingtonpathology.com

Cover Story:.State of the art GynecoloGic cytopatholoGy

other StorieS: acceSS GeneticS pcr aSSay four Step approach- cloSinG in on cervical cancer Meet our cytotechS

iN the NeWS: new faceS webSite provideS acceSS to patholoGy reportS SpeciMen trackinG anniverSary of new location

KathariNe LiU, M.D., F.C.a.P., F.a.S.C.P.board certified, anatomic and clinical pathology, cytopathology, hematopathology

areas of expertise: immunohistochemistry and Special Stains, Gynecologic pathology

DaviD G. MarCheSChi, M.D., F.C.a.P., F.a.C.P.board certified, anatomic and clinical pathology, cytopathology

areas of expertise: Gynecologic pathology, fine needle aspiration, and cytopathology

ChriStoPher D. MCKiNNey, M.D., F.C.a.P., F.a.S.C.P.board certified, anatomic and clinical pathology

areas of expertise: immunohistochemistry, flow cytometry, image analysis, and Molecular testing in neoplastic diseases

The Doctors of Wilmington PathologyBaBatUNDe a. oLatiDoye, M.D., F.C.a.P., F.a.S.C.P.board certified, anatomic and clinical pathology, cytopathology

areas of expertise: cytopathology, breast pathology, head / neck pathology, and oral pathology

BriaN C. Shiro, M.D., F.C.a.P., F.a.S.C.Pboard certified, anatomic and clinical pathology

areas of expertise: Gastrointestinal pathology, oral pathology, and immunohistochemistry

GreGory e. SteiNKraUS, Ph.D., a.B.M.M.diplomate, american board of Medical Microbiology

areas of expertise: antimicrobial therapy and Susceptibility testing; immunology, allergy, and autoimmune diseases; respiratory tract infections; noscomial infections; and Molecular diagnostic testing

JohN F. (JeFF) tUrNer, Jr., M.D., F.C.a.P., F.a.S.C.P.board certified, anatomic and clinical pathology hematology Special Qualification

areas of expertise: neoplastic hematopathology, General Surgical pathology, and non-neoplastic hematopathology

cervical cytopathologic screening (pap screening) has proven to be one of the most successful cancer prevention programs in history resulting in a marked decline in incidence of cervical cancer in countries with active screening programs. pap testing is not without problems however, and is not 100% sensitive or specific for detection of cancer or precancerous conditions. at wilmington pathology associates, we have traditionally been at the forefront of technological innovations that have significantly improved the accuracy of pap testing and continue to lead the way with implementation of new technologies, including our recent implementation of an improved method for detection of human papillomavirus, the underlying cause of cervical cancer.

wpa was the first independent laboratory in the region to implement monolayer technology providing the highest quality slide preparations possible by utilizing the thinprep™ system in 2002. we subsequently led the way by being third in the country to offer automated, computer-assisted screening, which significantly reduces the false negative fraction and improves the accuracy of cytologic diagnosis. we remain the only laboratory in the region with this advanced technology, which has been proven to increase detection rates for cervical cancer precursors.

in addition to these major advances, we have also initiated a molecular testing program that allows detection of human papillomavirus in cytologic samples, assisting the physician in management of patients with equivocal cytology results. our most recent advance has been implementation of polymerase chain reaction technology for detection and typing of human papillomavirus. this not only provides wpa with the most sensitive detection system available, the method allows specific typing and risk assessment of each of the many subtypes of hpv, providing more specific and meaningful information than ever before. hpv detection and typing by pcr was first offered in december of 2005 and since that time, we have seen a significant increase in our detection rates for all types of hpv, but specifically

State of the art Gynecologic CytopathologyBy Christopher D. McKinney, M.D.

Phone DirectoryMain office.................................................................910.362.9511

Fax...............................................................................910.362.9512

Patient Billing.............................................................800.851.5194

Physician office Billing...................... Cheryl Tolley. 910.202.1727

Cytology.......................................... Jeffrey Celeste. 910.202.1730

andrology......................................... Rebecca Lang. 910.202.1724

Patient reports ..................................Peg Wagner. 910.202.1722

Client Service..................................... Melissa Davis. 910.202.1719

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National Health ObservancesSeptemberovarian cancer awareness Monthprostate cancer awareness Monthleukemia and lymphoma awareness Month

OctObernational breast cancer awareness Month

NOvemberamerican diabetes Monthlung cancer awareness Monthpancreatic cancer awareness Month16th – Great american Smokeout

New FacesWilmington.Pathology.added.two.pathologists.

to. its. staff. this. year..David.G..Marcheschi,.MD.

is. board. certified. in. Anatomic. and. Clinical.

Pathology.as.well.as.Cytopathology..He.earned.

his. medical. degree. from. Medical. College. of.

Ohio.in.Toledo;.completed.his.residency.at.Duke.

University. Medical. Center. and. his. fellowship.

in. surgical. pathology. and. cytopathology. at.

University. of. Virginia. Heath. Sciences. Center.

in.Charlottesville,.VA..Dr..Marcheschi. and.his.

wife,.Ginga,.have.one.daughter.

Katharine.Liu,.MD.is.board.certified.in.Anatomic.

and. Clinical. Pathology,. Cytopathology. and.

Hematopathology..She.earned.her.medical.degree.

at. Duke. University. Me. . dical. Center. and..

completed. residency. programs. at. the. same.

institution.as.well.as.University.of.California,.

San. Diego.. Dr.. Liu. completed. fellowships.

in. Hematopathology. and. Cytopathology. –.

both.at.Duke.University.Medical.Center..Her.

husband. is.a.general. surgeon. in. Jacksonville.

and.they.have.a.three.year.old.son..

Website Provides Access to Pathology ReportsLog.On.to.our.website.-... .

www.wilmingtonpathology.com.-.. .

where.you.will.find.our.pathologists’.profiles,.

our. services,. news. releases. and. medical.

links..We. also. have. reporting.on.our.menu.

to. better. serve. our. clients.. This. service. will.

allow.you.to.view,.download.and.print.your.

patient.reports.with.just.a.few.mouse.clicks...

With.this.free.service.you.will.benefit.from

. -.24/7 access to reports

-.password protected access

-.90 day report accessibility

Call.our.office.to.request.a.user.name.and.password.

and.begin.using.online.reporting.today..

Specimen Tracking WPA. is. now. utilizing. an. electronic. tracking.

program. to. follow. the. transportation. of.

specimens. from. physician. offices. to. our.

laboratory..Our.requisitions.have.bar.coded.

stickers. for. application. to. specimen. bags. and.

our. couriers. scan. each. specimen. into. their.

handheld.device.upon.pickup.and.when.back.

at. the. lab,. scan.out. each. specimen.deposited.

in.our.accessioning.area..We.implemented.this.

system.as.a.Quality.Assurance.program.and.to.

make.our.courier.routes.more.efficient..

Anniversary of New Location Wilmington.Pathology.Associates.and.NextWave.

Diagnostic.Laboratories.have.now.been. in.our.

new.state.of.the.art.facilities.for.one.year.and.

in.April.hosted.an.open.house.for.the.medical.

community.. The. 15,000. square. foot. building.

has. allowed. the. group. to. implement. new.

technologies. and. medical. advances. and. has.

provided.patients.with.improved.access..If.you.

are.interested.in.visiting.our.facility.please.call.or.

stop.by.for.a.tour...

In The NewsGynecologic Cytopathology (continued)

Jeffrey Celeste, cytology Supervisor, joined wilmington pathology in June 2000. originally from new york, he has lived in numerous places as a result of growing up in a military family. Jeffrey attended Mount olive college where he earned degrees in biology and english then attended the cytology program at unc-chapel hill. Jeffrey

appreciates the personal relationships his job has allowed him to make. he says, “the people here at wpa and our clients are like one big extended family.”

Judy Knott’s career as a cytotechnologist spans 24 years. originally from durham, nc, she graduated from duke university cytology School in 1964. She has worked at emory university and Grady Memorial hospital in atlanta, Ga. in addition, she’s worked for Smith, kline and beecham and Quest diagnostics. Judy joined wpa in 2003

and appreciates the emphasis placed on high quality work and cooperation. “this is the most cooperative environment i have ever worked in,” she says.

Lynn Neubeck has been with wilmington pathology since november 2000 and is originally from long island, new york. lynn worked as a Med. tech. for sixteen years before entering the cytology program at unc-chapel hill and worked at their facility for five years before coming to wpa. lynn values the personal aspect of being

a cytotechnologist. She says, “a cytotech has a lot of personal responsibility in their job instead of letting machines do all the work.”

Linda Covil brings over 36 years experience as a cytotech to wpa. a native of wadesboro, north carolina, she graduated from wake forest university and received her cytology degree from north carolina baptist hospital-bowman Gray School of Medicine. linda has worked at charleston Memorial hospital in charleston,

South carolina and St. Joseph hospital in atlanta, Georgia. while at St. Joseph hospital, she participated in collaborations for the thinprep™ pap test to become fda approved. She says she heard cytology screening described as ‘looking at wallpaper with lots of flowers on it and you, the cytotech, have to pick out the ones that are different.’ linda joined wpa in 2000.

Mary Smith has been a cytotchnologist since 1980. She is originally from philadelphia, pa where she graduated from thomas Jefferson university with a bachelor’s degree in psychology. deciding that psychology was not the career path for her, she enrolled in cytology school. during her career, Mary has witnessed the progression of cytology

from the labor-intensive conventional pap test to today’s computer based technology. She says, “this is a valuable thing we do, diagnosing cervical cancer.” She has been with wilmington pathology associates since august 2001.

Nicole Wazny joined wilmington pathology in June of 2006 after relocating from buffalo, ny. She graduated from State university of new york health Science center at Syracuse in 1998 and has been a cytotech for eight years working for the last six at kaleida health, buffalo General.

we are happy to have her as the newest addition to our team..

MEET OUR CYTOTECHS

PHOTO NOT

AVAILABLE

for high-risk types, many of which were missed with older technology. this translates into more specific and accurate information for patients and physicians and allows more appropriate management of patients with this extremely common sexually-transmitted infection. More recently, we have begun to offer pcr-detection of chlamydia trachomatis and neisseria gonorrhea, utilizing samples collected for pap testing, further improving detection rates for infectious organisms, while minimizing the need for collection of additional specimens. in the future, we hope to offer additional ancillary testing from cervical cytology specimens including cystic fibrosis testing and possibly testing for detection of mutations associated with hereditary thombophilia.

it is important to emphasize that wpa strives to provide the most sensitive and accurate testing methodology available, coupled with outstanding service, to provide women in our region with the most accurate and timely pathology results possible. our staff of dedicated physicians and doctoral level scientists includes several board-certified and fellowship-trained subspecialists with interests and expertise in a wide range of pathology including cytopathology, hematopathlogy, microbiology, general surgical pathology and others.

Access Genetics PCR Assay Four Step Approach - Closing in On Cervical Cancerin november 2002 our laboratory began offering hpv testing from the thinprep™ vial. we were the first facility in Southeastern north carolina to offer this advancement in cervical cancer detection and diagnosis. the technology we chose was the digene capture ii hybrid test. this test used an in vitro nucleic acid hybridization assay with signal amplification using microplate chemiluminescence to detect the presence of 18 viral types of human papillomavirus and categorize them into either low-risk or high-risk. but the test is unable to determine the specific hpv type that is present.

advancements in technologies and methodologies have created a new form of hpv detection that can differentiate between the specific viral types. the access Genetics polymerase chain reaction (pcr) approach for hpv dna typing is now considered a more

advanced alternative for hpv detection. this groundbreaking technology utilizes a polymerase chain reaction (pcr) to not only identify the presence of the hpv virus but also distinguishes between the currently described high-risk types which are associated with the development of dysplasia or neoplasia; low-risk types; and a category of unclassified risk (see chart below). identifying specific types of hpv or combined types of the virus, gives clinicians more information and increases correlations between pap and colposcopy diagnosis and allows closer adherence to recommended acoG management guidelines and improving patient care.

our lab partners with access Genetics in a four Step approach to hpv typing. our facility completes the technical aspects of the test, which includes a step-by-step lab assay protocol. then, the images produced are securelytransmitted to access Genetics via the internet for interpretation by an access Genetics acMG-certified pathologist. our laboratory receives completed reports within hours, which are then combined with cytology results. the completed reports briefly present the results of the test and their significance for the specific patient and relevant risk associations from current medical literature.

utilizing this new technology for detecting and diagnosing human papillomavirus (hpv) enables us to give clinicians more specific information about their patient’s hpv type and deliver it to them in less time. physicians and healthcare providers can now develop more accurate strategies to manage their patients’ care based on the outcome of the access Genetics pcr approach.

*the assignment of risk of a given hpv involves several factors including the time since the infection was acquired, the patient's hormonal and immune status and whether there are coincident anogenital tract infections. current risk associations are compiled from published literature investigating the incidence of hpv infection within specific study populations as of July 2005.

hPv types Detected by accessPaP

16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 62, 66, 68, 73 (MM9), 82 (MM4), 83 (MM7;lvX82)

34, 55, 57, 64, 67, 71, 84 (MM8), cp8061, lvX160

6, 11(cp141), 30, 40, 42, 43, 44, 54 61, 69, 70, 72 (lvX100;cp4173), 74 81 (cp8304), cp6108

risk association for the development of dysplasia or neoplasia*

high risk

unclassified risk

low risk