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Obstetrician & Gynecologist (OB/GYN)
28 years of experience
Video profile

Education ?

Medical School Score
Stony Brook University (1982)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Colposcopy
Associations
American Board of Obstetrics and Gynecology
American Society for Colposcopy and Cervical Pathology

Affiliations ?

Dr. Lonky is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Kaiser Permanente Orange County - Anaheim Medical Center
    441 N Lakeview Ave, Anaheim, CA 92807
    • Currently 4 of 4 crosses
    Top 25%
  • West Anaheim Medical Center
    3033 W Orange Ave, Anaheim, CA 92804
    • Currently 3 of 4 crosses
    Top 50%
  • Harbor -Ucla Med Ctr, Torrance, Ca
  • Publications & Research

    Dr. Lonky has contributed to 19 publications.
    Title Cost-effectiveness of Adding Human Papilloma Virus Testing to a Managed Care Cervical Cancer Screening Program.
    Date December 2007
    Journal Journal of Lower Genital Tract Disease
    Excerpt

    OBJECTIVE: The purpose of this study was to demonstrate a methodology for auditing the impact of HCII testing on the direct cost of cervical cancer cytological screening, where the test is collected in all women screened and processed routinely in women age 30 years and older. MATERIALS AND METHODS: After a policy change to screen all patients 30 years or older with both Pap smears and high-risk human papillomavirus (HR-HPV), as well as cocollection of HR-HPV in women younger than 30 years, all cytological, HPV, and histological data pertaining to cervical screening was collected retrospectively during a 2-month period. We documented the direct costs of performing these tests and estimated the necessary compliance rate for balanced cost-effectiveness. RESULTS: During the 2-month period, 8,300 women were screened with both Pap smear and HPV cocollection. Of the 'nonnormal' cytological findings, 5% of patients showed either atypical squamous cells (3.5%) or squamous intraepithelial abnormalities (1.5%). An additional 427 (5%) patients had the finding of positive HR-HPV with normal cytology. Six of these patients opted for immediate colposcopy, 2 of which were found to have cervical intraepithelial neoplasia 2. In women age 30 years and older, 900 patients per 1,000 screened would be eligible for a 2-year screening interval based on negative cytology and negative HR-HPV. Based on the direct costs associated with this cohort, no more than 164 women could request screening at an interval shorter than 3 years for the total costs of such a program to equal that of one without HR-HPV cocollection. CONCLUSIONS: By adding HCII collection to the Pap smear for our entire screening cohort, we intended to reduce the number of tests performed, which was impacted by its age distribution. Our findings indicate that at least 736 of the 900 double-negative patients (82%) would have to be screened at no less than 3 years for such a screening paradigm to be cost-effective in managing women 30 years and older.

    Title Home Study Course: Winter 2007.
    Date February 2007
    Journal Journal of Lower Genital Tract Disease
    Title Transepithelial Sampling of the Uterine Ectocervix with a Stiff-bristled, Spiral-shaped Brush.
    Date May 2005
    Journal Journal of Lower Genital Tract Disease
    Excerpt

    OBJECTIVE: To measure the depth of sampling of the uterine ectocervix with the use of a stiff-bristled, spiral-shaped brush (SpiraBrush Cx; Trylon Corporation, Torrance, CA). MATERIALS AND METHODS: Eligible hysterectomy specimens were identified. The ectocervix was brushed with an inked SpiraBrush Cx in four quadrants with either light (gentle) or heavy (forceful) pressure. The depth of sampling was determined histologically. RESULTS: Four normal uteri were sampled a total of 15 times. The entire epithelium was removed to the epithelial-stromal junction in three specimens and in one sample only a few basal cells remained with light pressure. The depth of sampling ranged from 0.2 mm to 0.4 mm. Heavy pressure resulted in the entire removal of epithelium in six samples, with the depth of sampling ranging from 0.2 mm to 0.7 mm. The stroma was disrupted in one sample. Results were uninformative in five samples. CONCLUSIONS: Sampling of the uterine ectocervix with the SpiraBrush Cx seems to be transepithelial in most cases.

    Title False-negative Hybrid Capture Ii Results Related to Altered Adhesion Molecule Distribution in Women with Atypical Squamous Cells Pap Smear Results and Tissue-based Human Papillomavirus-positive High-grade Cervical Intraepithelial Neoplasia.
    Date May 2005
    Journal Journal of Lower Genital Tract Disease
    Excerpt

    OBJECTIVE: We investigated the detection of high-risk human papillomavirus DNA with the Hybrid Capture II test (HCII; Digene Corporation, Beltsville, MD) and the presence and pattern of distribution of adhesion molecules in biopsy-proven high-grade neoplastic lesions containing high-risk HPV-DNA from women with ASC cytology results. MATERIALS AND METHODS: We screened 4,600 women and performed colposcopy in 278 women with atypical squamous cells cytologic results. All women underwent HCII and tissue-based polymerase chain reaction analysis for high-risk HPV subtypes. Of 33 women with cervical intraepithelial neoplasia (CIN) 2 or worse biopsy results, 27 biopsy specimens contained sufficient tissue to perform immunohistochemical testing (pathologist blinded as to cytologic and HCII results) for adhesion molecules beta-catenin and 21 cases for E-cadherin. RESULTS: Five of 27 specimens with CIN 2 or worse biopsy results (18.5%) had negative HCII results. All five specimens showed evidence of high-risk human papillomavirus by polymerase chain reaction analysis. All five showed full-thickness distribution via immunohistochemical staining for beta-catenin. There was sufficient tissue to examine four of five specimens for E-cadherin, and a full-thickness distribution also was documented. CONCLUSIONS: Previous research linked false-negative cytologic results in women with high-grade CIN to altered adhesion molecule distribution and impaired exfoliation, and a similar phenomenon may be responsible for false-negative HCII results in women with atypical squamous cells cytologic results and high-grade CIN.

    Title Triage of Atypical Squamous Cells of Undetermined Significance with Hybrid Capture Ii: Colposcopy and Histologic Human Papillomavirus Correlation.
    Date April 2003
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To estimate the effectiveness of Hybrid Capture II to predict high-grade cervical intraepithelial neoplasia (CIN) from a cytological cervical sample. Evidence of high-risk human papillomavirus (HPV) was also determined from biopsy samples using the polymerase chain reaction (PCR) for women referred with atypical squamous cells of undetermined significance (ASCUS) Papanicolaou smears. METHODS: We screened 8170 women with Papanicolaou smears, of whom 278 (3.4%) returned ASCUS. All ASCUS cases underwent colposcopy and Hybrid Capture II testing. High-grade CIN biopsy specimens were tested for high-risk HPV by PCR. RESULTS: Nearly 30% of ASCUS cases had CIN biopsy results (11.9% showing CIN II or CIN III and 17.6% showing CIN I). Hybrid Capture II positive rates were 93.3% for cases with CIN III, 72.2% for CIN II, and 51.0% for CIN I (P <.001). ASCUS-Premalignant Process Favored cases showed a 28.1% high-grade biopsy rate and a 100% Hybrid Capture II positive rate. For ASCUS-Undefined and ASCUS-Reactive Process Favored cases, Hybrid Capture II returned positive in 90.9% of CIN III and 61.5% of CIN II cases (P <.001). Sixty-nine of 178 (38.8%) patients with no evidence of CIN tested positive for Hybrid Capture II. Human papillomavirus deoxyribonucleic acid (DNA) high-risk subtypes were detected by PCR in the tissue of all high-grade CIN cases with negative Hybrid Capture II results. CONCLUSION: Hybrid Capture II returned negative in 25% of cases with biopsy-proven high-grade CIN with associated high-risk HPV DNA by PCR (non-Premalignant ASCUS subset), and positive in 39.3% of cases with normal results; this limits its clinical utility.

    Title Reducing Death from Cervical Cancer Examining the Prevention Paradigms.
    Date January 2003
    Journal Obstetrics and Gynecology Clinics of North America
    Excerpt

    The prevention of morbidity and mortality from cervical cancer will hinge upon our understanding of the epidemiology, the molecular basis, and natural history of the disease and its associated precursors. This article serves as an introduction and presents our current challenge to prevent or find all women at risk, and alter the course of disease to effect a regression or a cure.

    Title Risk Factors Related to the Development and Mortality from Invasive Cervical Cancer Clinical Utility and Impact on Prevention.
    Date January 2003
    Journal Obstetrics and Gynecology Clinics of North America
    Excerpt

    The focus of this article is to explore the various risk factors related to cervical cancer and the practical context in which they can be applied. The ability to link dinical outcomes (disease presence, persistence, progression, and recurrence) with antecedent risk factors is strengthened by a new understanding of the molecular mechanisms that are responsible for malignant transformation.

    Title A Stiff Bristled, Spiral-shaped Ectocervical Brush: a Device for Transepithelial Tissue Biopsy.
    Date January 2003
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To compare a new spiral-shaped tissue-sampling brush with a standard cervical punch biopsy. METHODS: Before large loop excision of the transformation zone, women with cervical intraepithelial neoplasia underwent a transepithelial brush biopsy of a portion of a colposcopically identified lesion, followed by a punch biopsy of the remaining portion. Brush biopsy samples were processed using liquid-based cytology and cell block techniques. Diagnoses were made using a consensus of three pathologists. Brush biopsy samples without basal cells were considered inadequate. The histological diagnosis was compared with the brush biopsy and punch biopsy samples. Patient-reported pain and physician-reported bleeding for punch and brush biopsies were compared. RESULTS: Fifty-two women were enrolled in the study; 47 successfully completed the study protocol. Eight brush biopsy specimens were inadequate. Thirty-nine women showed abnormal pathology (human papillomavirus/cervical intraepithelial neoplasia I or worse) on large loop excision of the transformation zone, and 32 women had high-grade (or worse) lesions. The punch biopsy correlated with high-grade disease in 53.1% of these women. The brush biopsy result correlated with high-grade disease in 79.3% of these women using a cell block technique and 76.7% using liquid cytology. There was significantly less pain (P <.001) and significantly less bleeding (P <.001) with the brush biopsy. CONCLUSION: When an adequate sample is collected, spiral brush biopsy is as good as a standard punch biopsy for detecting cervical pathology, with substantially less pain and bleeding. User training and guidelines for sampling are needed to assure that an adequate sample is collected.

    Title Aberrant Expression of E-cadherin in Cervical Intraepithelial Neoplasia Correlates with a False-negative Papanicolaou Smear.
    Date July 2002
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVES: E-cadherin is responsible for cell adhesion in normal cervical epithelium. It is normally absent in the superficial epithelial layers, allowing for exfoliation. We investigated the correlation between E-cadherin distribution and Papanicolaou smear in subjects with cervical dysplasia. STUDY DESIGN: Tissue samples from 25 women with cervical dysplasia were tested for E-cadherin, beta-catenin, and alpha-catenin expression by immunohistochemistry. The expression pattern of these proteins, whether full thickness or restricted to the basal layers, was correlated with the Papanicolaou smear result. RESULTS: Of 12 women with normal Papanicolaou smears, 10 of 11 informative cases demonstrated E-cadherin expression throughout all epithelial layers. Eight of 10 informative cases with an abnormal Papanicolaou smear showed E-cadherin only at the basal layers. Alpha-catenin was distributed throughout the entire epithelium in samples of all 25 women. CONCLUSIONS: Expression of E-cadherin throughout all epithelial layers was correlated with a false-negative Papanicolaou smear. It is likely that aberrant persistence of E-cadherin in these lesions interferes with the exfoliation of abnormal cells.

    Title The Clinical Significance of the Poor Correlation of Cervical Dysplasia and Cervical Malignancy with Referral Cytologic Results.
    Date October 1999
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: We prospectively studied the diagnostic utility of our Bethesda system-based cervical cytology screening program with colposcopy and biopsy as the criterion standard. STUDY DESIGN: We prospectively collected and studied the correlation of cytologic, colposcopic, and histologic data in women referred for colposcopic examination because of "nonnormal" cytologic results or other risk factors. RESULTS: We found that 771 of 5585 initial colposcopic visits yielded high-grade (cervical intraepithelial neoplasia II or worse) biopsies (13.8% prevalence); 13 showed invasive cancer (0.23% prevalence). Only 132 of 771 cases of high-grade dysplasia (17%) and 5 of 13 cases of invasive cancer (38%) followed Papanicolaou smears suggesting high-grade intraepithelial lesions or cancer, with 77% being discovered after "minor" Papanicolaou smear abnormalities. High-grade disease or cancer was confirmed in 1 of 2 high-grade or cancer Papanicolaou referrals and in 1 of 11 referrals with atypical squamous cells of undetermined significance. CONCLUSION: Papanicolaou smears, especially those that are low grade, should not be equated with histologic sampling in association with poor cytohistopathologic correlation. Most high-grade dysplasias and cancers occur in women with either minor Papanicolaou smear abnormalities or visible lower genital tract lesions or both. Colposcopy for women with any "nonnormal" screening result is feasible.

    Title Ability of Visual Tests to Predict Underlying Cervical Neoplasia. Colposcopy and Speculoscopy.
    Date December 1995
    Journal The Journal of Reproductive Medicine
    Excerpt

    OBJECTIVE: To describe the attributes of colposcopy and a low-power, magnified examination that utilizes chemiluminescent illumination (speculoscopy) in the visualization of cervical epithelium in a predefined, high-risk population and to compare how the two tests predict cervical histology. STUDY DESIGN: During this multicenter, prospective study, 395 women who were referred to our colposcopy clinic underwent a repeat cervical smear and speculoscopy followed immediately by colposcopy. Abnormal colposcopic lesions were biopsied and endocervical curettage performed when indicated. Histologic diagnoses were compared with cytology, speculoscopy and colposcopy results. RESULTS: Colposcopy was more sensitive than speculoscopy in the detection of cervical neoplasia (97% vs. 82%) (P < .001) and was superior in visualizing focal lesions and vascular patterns. An antecedent acetowhite abnormality detected during speculoscopy was highly predictive of subsequent abnormal colposcopy (97% positive predictive value). The "overall" rate of acetowhite lesions during speculoscopy was nearly half the rate during colposcopy (P < .001). CONCLUSION: Colposcopy is better suited than speculoscopy to the follow-up of patients with abnormal cervical cytology because it facilitates lesion grading and assists in directing biopsies. Speculoscopy is best utilized as a dichotomous screening test based on the presence or absence of at least one well-demarcated acetowhite lesion and may be more suitable than colposcopy as an adjunct to cervical cancer screening due to its lower overcall rate. The biophysical properties of blue-white chemiluminescent light as it relates to the diagnosis of cervical neoplasia are discussed.

    Title Low-grade Papanicolaou Smears and the Bethesda System: a Prospective Cytohistopathologic Analysis.
    Date May 1995
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To examine the clinical usefulness of the Bethesda classification system of low-grade cervicovaginal cytology as it relates to predicting underlying histology and aiding in triage to colposcopy. METHODS: We evaluated 1454 women with abnormal cytologic screening results: 782 with atypical squamous cells of uncertain significance (atypia), 355 with low-grade squamous intraepithelial lesions (SIL) determined by the presence of human papillomavirus (HPV) alone, and 317 with low-grade SIL determined by the presence of cytologic evidence of mild dysplasia (cervical intraepithelial neoplasia [CIN] I) devoid of HPV cytopathologic features. All women underwent colposcopy, directed-punch biopsy or loop electrosurgical excision, and/or endocervical curettage (ECC), as indicated. RESULTS: Women from the low-grade SIL-CIN I referral cytology group were significantly more likely to harbor all grades of biopsy-proven dysplasia than were those from the atypical squamous cells of uncertain significance and low-grade SIL-HPV groups, which showed no statistical differences. CONCLUSIONS: Contrary to the Bethesda system, which combines CIN I and HPV changes because of cytomorphologic similarities, this study suggests that patients with HPV cytologic smears are similar to patients with atypical smears and are less likely to harbor any biopsy-proven CIN lesions than are patients with CIN I cervicovaginal smears. If excluded from colposcopic triage, approximately 5% of patients with atypical cytologic smears from a well-screened population similar to ours will harbor high-grade lesions that may progress during any waiting period. Triage of low-grade cervicovaginal smears based on histopathologic correlation is encouraged.

    Title Use of Speculoscopy in the Evaluation of Women with Atypical Papanicolaou Smears. Improved Cost Effectiveness by Selective Colposcopy.
    Date June 1993
    Journal The Journal of Reproductive Medicine
    Excerpt

    Since up to 45% of patients with atypical Papanicolaou smears have been shown to have significant pathology, women with persistent atypia are usually referred for colposcopy. This study evaluated the use of a new adjunctive screening test, speculoscopy, in selecting women with atypical Papanicolaou smears who would most benefit from referral for colposcopy. Both screening and referral patients were evaluated with the Papanicolaou smear, speculoscopy and colposcopy at 10 study centers. Biopsies were obtained from most women with positive colposcopy. The results in patients with atypical smears were used to perform a cost-benefit analysis of each of three management protocols. Using the results of speculoscopy to select women with atypical Papanicolaou smears for colposcopy provided a cost-effective alternative to performing colposcopy either on all women or on those with persistent atypia following treatment. Even when all women undergo speculoscopy at the time of screening, this protocol provides a cost savings of up to 24% and no significant loss of diagnostic accuracy. These data suggest that speculoscopy performed at the time of initial screening can accurately select women with atypical Papanicolaou smears who require colposcopy for diagnostic biopsy in a cost-effective manner.

    Title Diagnosing Human Papillomavirus of the Female Lower Genital Tract: Failure of the Pap Smear As a Sole Screening Test.
    Date August 1992
    Journal Journal of Gynecologic Surgery
    Excerpt

    Of 197 patients referred for colposcopy who underwent repeat Pap smears and colposcopic biopsies (when indicated), histologic evidence of human papillomavirus (HPV) infection involving the endocervix, cervix, or vagina or all three sites was documented in 109 biopsies. Sixty-six (61%) had normal Pap smears at the time of colposcopy. Despite a specificity of 92% for detecting HPV, the Pap smear demonstrated a low sensitivity (39%), with a positive and negative predictive test value of 88% and 50%, respectively. In patients with biopsies revealing HPV infection without associated dysplasia, false negative Pap smears were found most often in women with strictly vaginal HPV (74%) (P less than 0.05), followed by those with coexistent cervical and vaginal HPV (65%), and then by those with solely cervical HPV (51%). We question the use of the Pap smear for the detection of lower genital tract HPV, particularly in patients with only vaginal involvement, especially when the smear is repeated at the time of colposcopy. Benefits and disadvantages of other screening tests for HPV are discussed.

    Title External Cephalic Version After Previous Cesarean Section.
    Date September 1991
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    Approximately 100,000 cesarean sections are performed each year in the United States because of breech presentation. Numerous studies have shown that external cephalic version can eliminate the need for many of these operations. However, because of the fear of uterine rupture, these studies have generally excluded patients who have undergone previous cesarean section. To evaluate the validity of this exclusion policy, we studied patients with one or more previous cesarean sections and breach presentations near term. Version attempts were successful in 82% of 56 patients who had undergone a previous cesarean section. Sixty-five percent of the successful version patients went on to have vaginal birth after cesarean section. There were no serious maternal or fetal complications associated with the version attempts. We conclude that external cephalic version is a reasonable option in patients with prior low transverse cesarean section.

    Title Prediction of Cesarean Section Scars with Ultrasound Imaging During Pregnancy.
    Date March 1989
    Journal Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    Excerpt

    We sought to determine whether a sonographic examination could identify uterine scars in patients with a history of previous cesarean section and further distinguish patients having previous low transverse from vertical uterine incisions. Forty-six antenatal obstetrical patients with a history of prior cesarean section(s) and 30 control patients without prior uterine surgery underwent sonogram examinations to identify the scar. The researcher who later reviewed the sonogram was blinded as to the presence or type of uterine scar. Of the 47 scars examined, uterine scars were visualized in 13 (27.7%). All scars seen were low transverse; no vertical scars were identified by sonography (p less than .05). No scars were visualized with sonography in the control group and cesarean section scars were seen more easily prior to the third trimester. No information concerning the scar condition (dehiscence) could be obtained with sonography. We conclude it is of benefit to perform sonogram exams in patients with prior cesarean sections of unknown incision to better counsel them as to their risk to rupture. Although vertical cesarean section scars could not be visualized, those patients who had low transverse scars identified could be included in a low-risk vaginal birth population.

    Title A Proposed Mechanism for Premature Rupture of Membranes.
    Date March 1988
    Journal Obstetrical & Gynecological Survey
    Title Ectopic Pregnancy with Shock and Undetectable Beta-human Chorionic Gonadotropin. A Case Report.
    Date October 1987
    Journal The Journal of Reproductive Medicine
    Excerpt

    A patient with an ectopic pregnancy presented with intraabdominal hemorrhage, hypotension and a beta-human chorionic gonadotropin (beta-hCG) less than 5 mIU/mL. Although rare, a negative beta-hCG does not rule out the diagnosis of ectopic pregnancy.

    Title Poor Correlation of High-grade Cervical Dysplasia with Referral Cytology: Clinical Implications.
    Date
    Journal Primary Care Update for Ob/gyns
    Excerpt

    Objective: We questioned the diagnostic utility of cervical cytology by studying whether women with colposcopically guided biopsy proven high-grade cervical dysplasia or cancer had referral cytology results that correlated highly with their disease.Methods: All women with any cytologic abnormality or visible lower tract lesion(s) are referred for colposcopic examination. Ten thousand visits to our colposcopy clinic were prospectively collected, tracked, and reviewed, which revealed 566 cases of high-grade dysplasia and 8 cancers on biopsy. The proportion of high grade disease that was discovered by high grade cytology was measured.Results: The diagnosis of high grade cervical disease was not preceded by high-grade cytology (HGSIL) or "rule out cancer" cytology result (n = 95, 16.8%) in the majority of cases (P <.0001, chi(2)). High-grade disease was more often preceded by low-grade cytology (LGSIL) (n = 224, 39.5%), followed by atypical Papanicolaou smears (ASCUS) (n = 220, 38.9%) and visible cervical or vaginal lesion(s) (n = 27, 4.8%). A very high percentage of cancer cases had preceding HGSIL cytology (6 of 8 cases at least HGSIL, 75%).Conclusion: High-grade cervical neoplasia was more likely to be discovered following colposcopic triage of "minor" Papanicolaou smear abnormalities (ASCUS or LGSIL). The false negative rate of a single Papanicolaou smear to detect dysplasia may be as high as 65% (with specificity at the 90% range) (Fahey MT, Irwig L, Macaskill P. Meta analysis of Pap test accuracy. Am J Epidemiol 1995;141:7:680-9), making cytology an inaccurate diagnostic replacement for colposcopy. We should rethink the significance of minimally abnormal Papanicolaou smears when designing triage protocols that delay or eliminate colposcopy based on the Bethesda Grading System alone.

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