African Pathologists Research Articles

Multinational, Multicenter Evaluation of Prostate Cancer Tissue in Sub-Saharan Africa: Challenges and Opportunities.

Prostate cancer disproportionately affects men of African descent, yet their representation in tissue-based studies is limited. This multinational, multicenter pilot study aims to establish the groundwork for collaborative research on prostate cancer in sub-Saharan Africa. The Men of African Descent and Carcinoma of the Prostate network formed a pathologist working group representing eight institutions in five African countries. Formalin-fixed paraffin-embedded prostate tissue specimens were collected from Senegal, Nigeria, and Ghana. Histology slides were produced and digitally scanned. A central genitourinary pathologist (P.L.) and eight African general pathologists reviewed anonymized digital whole-slide images for International Society of Urological Pathology grade groups and other pathologic parameters. Discrepancies were re-evaluated, and consensus grading was assigned. A virtual training seminar on prostate cancer grading was followed by a second assessment on a subcohort of the same tissue set. Of 134 tissue blocks, 133 had evaluable tissue; 13 lacked cancer evidence, and four were of insufficient quality. Post-training, interobserver agreement for grade groups improved to 56%, with a median Cohen's quadratic weighted kappa of 0.83 (mean, 0.74), compared with an initial 46% agreement and a quadratic weighted kappa of 0.77. Interobserver agreement between African pathologist groups was 40%, with a quadratic weighted kappa of 0.66 (95% CI, 0.51 to 0.76). African pathologists tended to overgrade (36%) more frequently than undergrade (18%) compared with the reference genitourinary pathologist. Interobserver variability tended to worsen with a decrease in tissue quality. Tissue-based studies on prostate cancer in men of African descent are essential for a better understanding of this common disease. Standardized tissue handling protocols are crucial to ensure good tissue quality and data. The use of digital slide imaging can enhance collaboration among pathologists in multinational, multicenter studies.

The untapped potential of digital pathology in prostate cancer diagnosis and medical education in sub-Saharan Africa

IntroductionProstate cancer exerts a significant burden of disease in sub-Saharan Africa. Late clinical presentation with metastatic disease at diagnosis and the lack of structured national screening programs are unsolved issues. The delay in prostate cancer diagnosis is in part due to the severe shortage of African pathologists with inadequate or inaccessible diagnostic infrastructure playing a contributory role to this problem. DiscussionDigital pathology platforms could offer new solutions to the diagnostic and educational challenges facing pathologists practicing in Africa. For prostate cancer, they could provide several advantages including the assessment of biopsy cores, measurement of tumor volumes and second opinion consultation of difficult cases. They may also be an outstanding tool in developing Gleason tutorials for educational and standardization purposes. ConclusionA transition to digital pathology in sub-Saharan Africa could yield incremental benefits to the quality of pathology diagnosis and highlight the growing capacity of digital pathology as a sub-speciality educational tool in the training of African pathologists both in prostate pathology and other pathology sub-specializations.

Abstract P5-09-07: Using the power of the internet to deliver breast teaching in Africa

Abstract Introduction: Delivering high quality breast teaching to African countries is of utmost importance. Our previous audit of breast cancer reporting in Africa has identified areas that would benefit from teaching and education. However, time and resource issues limit the ability to deliver teachings to a large number of African pathologists in person. Method As part of a comprehensive national in house teaching for senior trainees in Nigeria, a distant module of teaching was delivered by a team of UK pathologists using a freely available internet application. Results Distant teaching formed part of a two week residential postgraduate histopathology course that was designed for trainees preparing for their exit Histopathology exam. Sixty African pathologists attended the teaching. Previous auditing of breast cancer reporting indicated the need for education on macroscopic specimen handling, typing and grading of breast cancer. Other topics included an update on inflammatory breast cancer which has a high incidence in Africa and columnar cell lesions that are increasingly being encountered by African pathologists in the context of breast screening. A set of anonymous virtual slides were scanned and distributed to delegates before the course date. Teaching was delivered using Skype application that only required a computer with internet access at the UK and Nigeria. We utilised video-conferencing which allowed trainees to see their lecturers and vice versa. The new data sharing facility of the application allows simultaneous sharing of Power Point presentations, with annotation which facilitates interactive discussion. A slide seminar using the previously circulated virtual slides, covering areas of diagnostic challenges morphologically and by immunohistochemistry was also delivered. An approach to diagnosing these lesions was delivered with re-focussing on tumor typing and grading. Participants were able to ask questions and interact with the UK-based tutors thorough the sessions. The feedback collected from attendees was excellent. Conclusion Distant teaching using freely available internet applications is a valuable, time and cost effective method that allows sharing educational material including lectures and slide seminars in an interactive manner. It is particularly useful in delivering teaching to resource-poor countries. Citation Format: Shaaban AM, Abdulkareem F, Rotimi O. Using the power of the internet to deliver breast teaching in Africa. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-09-07.

Accuracy of Clinical Suspicion and Pathologic Diagnosis of Kaposi Sarcoma in East Africa.

Background:HIV-associated Kaposi sarcoma (KS) is one of the most common malignancies in sub-Saharan Africa. The diagnosis is often based on clinical suspicion, without histopathologic confirmation. When biopsies are performed, the accuracy of interpretation by local pathologists is poorly understood. We assessed the accuracy of clinical suspicion and pathologic diagnosis of KS in 2 East African countries.Methods:At 2 large HIV care sites in Uganda and Kenya, we evaluated consecutive biopsies performed from October 2008 to January 2013 on HIV-infected adults with clinically suspected KS. Biopsies were interpreted by both local African pathologists and a group of US-based dermatopathologists from a high volume medical center. For the purpose of this analysis, the US-based dermatopathologist interpretation was used as the gold standard. Positive predictive value was used to characterize accuracy of local African clinical suspicion of KS, and concordance, sensitivity, and specificity were used to characterize accuracy of local pathologic diagnosis.Results:Among 1106 biopsies, the positive predictive value of clinical suspicion of KS was 77% (95% confidence interval: 74% to 79%). When KS was not histopathologically diagnosed, clinically banal conditions were found in 35%, medically significant disorders which required different therapy in 59% and life-threatening diseases in 6%. Concordance between African pathologists and US-based dermatopathologists was 69% (95% confidence interval: 66% to 72%). Sensitivity and specificity of African pathologic diagnoses were 68% and 89%, respectively.Conclusions:Among East African HIV-infected patients, we found suboptimal positive predictive value of clinical suspicion of KS and specific, but not sensitive, histopathologic interpretation. The findings call for abandonment of isolated clinical diagnosis of KS in the region and augmentation of local dermatopathologic services.

Proceedings of the African Pathologists Summit; March 22-23, 2013; Dakar, Senegal: a summary.

This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer. To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them. Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa-United States and Canadian Academy of Pathology Initiative; International Academy of Pathology; International Network for Cancer Treatment and Research; National Cancer Institute; National Health and Laboratory Service of South Africa; Nigerian Postgraduate Medical College; Royal College of Pathologists; West African Division of the International Academy of Pathology; and Faculty of Laboratory Medicine of the West African College of Physicians. Information on the status of the practice of pathology was based on the experience of the participants, who are current or past practitioners of pathology or are involved in pathology education and research in Sub-Saharan Africa. The deliberations were carried out through presentations and working discussion groups. The significant lack of professional and technical personnel, inadequate infrastructure, limited training opportunities, poor funding of pathology services in Sub-Saharan Africa, and their significant impact on patient care were noted. The urgency of addressing these issues was recognized, and the recommendations that were made are contained in this report.

Intra- and Interobserver Reproducibility of Grading ofHelicobacter pyloriGastritis According to the Updated Sydney System

Aims. To study the intra- and interobserver reproducibility of Sydney System amongst pathologists in Cameroon as Sydney System gradation has not gained enough confidence in African pathologists. Methods. We performed a descriptive study including 100 patients who benefited from gastric biopsy by endoscopy. These biopsy specimens were stained with hematein and eosin and modified Giemsa, and read independently using the same microscope by two pathologists with four years experience and no experience with the updated Sydney System. Gastritis was graded according to the updated Sydney System. Levels of intra- and interobserver reproducibility were assessed using the unweighted kappa coefficient. Results. The intraobserver reproducibility of gradation of Helicobacter pylori density, activity, chronic inflammation, atrophy, and intestinal metaplasia showed respective values of kappa: 0.63, 0.34, 0.61, 0.48, and 0.82 for one observer against 0.42, 0.005, 0.41, 0.31, and 0.72 for the other. Interobserver reproducibility kappa values were, respectively, 0.41, 0.18, 0.57, 0.58, and 0.82. Conclusion. Results are encouraging but experience in the updated Sydney System should be improved. The later should be introduced as a means to grade and classify gastritis in Cameroon and African countries.

The XXIXth Congress of the International Academy of Pathology

The XXIXth Congress of the International Academy of Pathology (IAP), held September 29 to October 5, 2012, in Cape Town, South Africa, was the first IAP congress held on the African continent. A total of 1,282 delegates from 87 countries attended the congress. Because the congress was being held in Africa and because of the emerging importance of diagnostic pathology on that continent, special efforts were made to recruit African pathologists to the meeting. These efforts were highly successful; 337 African pathologists attended the congress: 325 from 21 sub-Saharan countries and 12 from 2 Saharan countries. By 1 estimate, this represents more than 50% of the pathologists from sub-Saharan Africa—a remarkable percentage. Part of the efforts to increase attendance by African pathologists was by providing bursaries to cover the costs of travel and registration. This was highly successful, with 158 bursaries awarded, the greatest …

Assisting cytopathology training in medically under‐resourced countries: Defining the problems and establishing solutions

Cytology is able to deliver rapid accurate diagnoses with minimal equipment and laboratory infrastructure at minimal cost, and this is especially so for fine needle biopsy (FNB), which is a powerful diagnostic tool in medically resource-poor environments, where histopathology laboratories are small in number and poorly supported financially. The crucial element in the development of cytology services is to train a sufficient number of well trained cytopathologists and cytotechnologists to create a 'critical mass' of personnel who not only provide routine diagnostic services, but also can train an ever expanding number of pathologists, cytotechnologists, and health workers. A review of practical programs to train cytopathologists and cytotechnologists in their own countries will be presented, including a recent series of FNB and cytology tutorials run in sub Saharan Africa. The need for local cytopathology programs and the potential for both local and visiting cytopathologists to provide a faculty will be discussed, as well as a range of possible programs which can bring African pathologists and trainee pathologists to Western institutions for periods of their training. Ideally, the regional Societies of Cytology, including the recently formed West African Society of Cytology, will establish their own diagnostic protocols, training programs, syllabuses, examinations and accreditation and career pathways for both cytopathologists and cytotechnologists, and organize tutorials where they will invite overseas faculty to contribute. Crucially, these new societies will empower cytopathologists and cytotechnologists to approach health services and governments to state the need for cytology services as a cost-effective accurate diagnostic service that enhances patient care.