Biopsy case mix and diagnostic yield at a Malawian central hospital|
Mtonga, P.; Masamba, L.; Milner, D.; Shulman, L. N.; Nyirenda, R. & Mwafulirwa, K.
Cancer is a major disease burden worldwide resulting in high morbidity
and mortality. It is the leading cause of mortality in developed countries
and is one of the three leading causes of death for adults in developing
countries. Pathological examination of tissue biopsies with histological
confirmation of a correct cancer diagnosis is central to cancer care.
Without an accurate and specific pathologic diagnosis, effective treatment
cannot be planned or delivered. In addition, there are marked geographical
variations in incidence of cancer overall, and of the specific cancers
seen. Much of the published literature on cancer incidence in developing
countries reflects gross estimates and may not reflect reality. Performing
baseline studies to understand these distributions lays the groundwork for
further research in this area of cancer epidemiology. Our current study
surveys and ranks cancer diagnoses by individual anatomical site at Queen
Elizabeth Central Hospital (QECH) which is the largest teaching and
referral hospital in Malawi. A retrospective study was conducted reviewing
available pathology reports over a period of one full year from January
2010 to December 2010 for biopsies from patients suspected clinically of
having cancer. There were 544 biopsies of suspected cancer, taken from
96 anatomical sites. The oesophagus was the most common biopsied site
followed by breast, bladder, bone, prostate, bowel, and cervical lymph
node. Malignancies were found in biopsies of the oesophagus biopsies
(squamous cell carcinoma, 65.1%; adenocarcinoma, 11.6%), breast
(57.5%), bladder (squamous cell carcinoma, 53.1%) and stomach (37.6%).
Our study demonstrates that the yield of biopsy for clinically suspected
malignancy was greater than 50% for the 11 most common sites and
provides a current survey of cancer types by site present in the population
reporting to our hospital.