Histology Laboratory Research Articles

A slide into obscurity? The current state of histology education in Australian and Aotearoa New Zealand medical curricula in 2022-2023.

Australia and Aotearoa New Zealand (AANZ) medical schools have been impacted by curricular changes and the introduction of virtual microscopy (VM). No survey has explicitly described the outcome of these events on histology education in AANZ. This study provides a cross-sectional overview of histology education in accredited medical schools across AANZ in 2022-2023. Responses were received from 83% (19/23) of Australian medical schools, and 50% (1/2) of medical schools in Aotearoa New Zealand. VM, either exclusively (42%) or combined with traditional microscopy (37%), emerged as the preferred mode for delivering histology education. Common instructional methods included face-to-face lectures (26%) and synchronous online live lectures (26%). A significant proportion (84%) of educators supplemented resources with virtual microscopy websites. Integration of histology education was prevalent (79%), primarily with pathology (32%) or gross anatomy (26%). On average, medical students in the region spent a maximum of 21 ± 17 h in face-to-face histology laboratories throughout their degree. Histology education was predominantly taught by academics with a PhD degree. This study also examined the similarities and differences in histology education between AANZ and the global landscape. Through this examination, the present study positions AANZ within the broader context of histology education worldwide discusses key factors impacting histology education, and advocates for action to mitigate a looming shortage of pathologists in AANZ. In light of these findings, AANZ medical schools should integrate histology and pathology, establish a core curriculum, and promote flexible teaching modalities.

Histological methods for plant tissues

ABSTRACT Although many of the structures and organelles of vegetative cells are comparable to those of animal tissues, significant differences between the two kingdoms require modifications in histological techniques for both tissue processing steps and histochemical staining techniques. The authors investigated the challenges of working with plant tissues by collecting various flora to represent the four main plant organs: leaf, stem, root, and flower/fruit. Triplicate samples for each specimen were placed into formalin for paraffin embedding, placed into formalin for later frozen sections, and used fresh to undergo immediate frozen sectioning. Frozen sections of plant tissues were more difficult to obtain than formalin-fixed paraffin-embedded (FFPE) sections, exhibited tissue loss during staining, and were inferior morphologically to FFPE sections. Although, historically, plant tissue fixation and processing has employed several different reagents compared with those used in animal tissue processing and took significantly longer times, the current investigation determined reagents and protocols from a modern histology laboratory which processes mammalian tissues can be applied to plant tissue processing with only slight modifications in respect to reagent timing. Additionally, staining techniques were compared and while it is well known that plant cell walls stain well with safranin O, the current investigation determined the uptake of safranin O can be accelerated by incubating at 60°C.

Estimation of Programed Death Ligand_1 Concentrations in Serum and Tissue Among Iraqi Breast Diseases

Abstract Background: A programed death ligand L1 is the particular PD-1 ligand that is primarily found in lymphoid, epithelial, and myeloid cells. In order to activate the PD-1/PD-L1 pathway, which suppresses the production of cytokines and controls immune function, PD-1 must bind to PD-L1. Objectives: Estimating the concentration of PDL_1 in serum and breast tissue of patients with breast tumors. Materials and Methods: Case–control study included 100 women (17–60 years old) undergoing breast surgery at Babylon Province’s Al-Hilla Teaching Hospital and Al-Fayhaa Al Ahly Hospital provided blood and breast tissue samples. Hospital histology lab performed histological confirmation of breast diseases, including benign and malignant tumors. Twenty blood samples were taken as controls from women and men who appeared to be in good health. The enzyme-linked immunosorbent assay was used to determine PDL_1 in both patient and control serum and in the cell supernatant from the patient’s breast tissues. Results: The mean level of PDL_1 in serum of patient was 549.37 ng/L while control was 594.22 ng/L with found significant differences where P value was 0.05. While tissue of patients was 464.97 ng/L. The results appeared concentrations of PDL-L1 were significantly higher in serum compared with tissues at P ≥ 0.05. The results found no significantly differences in concentrations of PDL_1 among types of diseases in sera of patients except in fat necrosis patients. Perhaps as a result of our small sample size, the difference in PD-L1 expression between the various subtypes was not statistically significant. Conclusion: This study found concentration of PDL-1 decreased with primary breast diseases and it might be diagnostic marker.

Estimation of Toll-like Receptors- 9 Levels in Iraqi Breast Cancer Patients

Background: Innate receptor called toll-like receptor 9 is capable of identifying both microbial and vertebrate DNA.It has been found in both normal mammary gland epithelial cells and breast milk cells.TLR-9was estimated in serum of patients and breast tissue for breast disease. Methods: A 100 women (17–60 years old) were determined undergoing breast surgery at Babylon Province's Al-Fayhaa Al Ahly Hospital and AL-Hilla Teaching Hospital provided blood and breast tissue samples. Hospital histology lab and clinical surgery performed histological confirmation of breast diseases( benign and malignant tumors). Twenty blood samples were taken as controls from women who appeared to be in good health. TLR9 was measured in the serum of patients with breast diseases as well as the control group using ELIZA. Results: The mean level of TLR9 in serum of patient was 339.4667 ng/l while control was 316.9929 ng/l with found significant differences where P_value was (0.05). while tissue of patient was 276.1064 ng/l. Concentrations of TLR9 were significantly higher in serum compared with tissues at (P≥0.05).The results found no significantly differences in concentrations of TLR9 among types of diseases in sera of patients. This study found concentration of TLR9 increased with primary breast diseases and it might be prognostic marker Conclusion : This study found concentration of TLR 9 increased with primary breast diseases and it might be prognostic marker

Tissue Processing using Microwave Oven: A Boon for Histology Slide Preparation

Background: Tissue processing is an important step in histology laboratories. Routine tissue processing is time-consuming. Due to the same time factor, microwave tissue processing is now increasingly being used in many histology and pathology laboratories. Objective: To compare the time taken to process the tissues using the routine conventional and microwave methods. Methods: The study was conducted in the Histology laboratory. 100 slides (50 conventional method + 50 microwave method) were processed using both methods, sectioned, stained, and analyzed by an independent observer who was unaware of the processing method. Results: The study showed a significant decrease in processing time by the microwave method (p-value < .0001). Conclusion: The present study concluded that the time taken for dehydrating, clearing, and embedding the tissues in paraffin wax was found to be considerably lower than that taken for the conventional method of tissue processing. Chloroform was used here as a clearing agent, and it had desirable effects. KEYWORDS: Microwave tissue processing, Conventional tissue processing.

A Scalable Histological Method to Embed and Section Multiple Brains Simultaneously.

The preparation and processing of rodent brains for evaluation by immunohistochemistry is time-consuming. A large number of mouse brains are routinely used in experiments in neuroscience laboratories to evaluate several models of human diseases. Thus, methods are needed to reduce the time associated with processing brains for histology. A scalable method was developed to embed, section, and stain multiple mouse brains using supplies found in any common histology laboratory. Section collection schemes can be scaled to provide identical bregma locations between adjacent sections for immunohistochemistry, facilitating comprehensive, high-quality immunohistochemistry. As a result, sectioning and staining times are considerably reduced as sections from multiple blocks are stained simultaneously. This method improves on previous procedures and allows multiple embedding and subsequent immunostaining of brains easily with a dramatically reduced time requirement. Furthermore, we expand this method for use in numerous mouse tissues, rat brain tissue, and post-mortem human brain and arterial tissues. In summary, this procedure allows the processing of many rodent or human tissues from perfusion through microscopy in 10 days or less.

DIY peristaltic perfusion pump and rotarod apparatuses from common and recycled materials

To reduce the high costs of research associated with specialized laboratory equipment, the current study aimed to construct and validate two devices (peristaltic perfusion pump and rotarod) critical in physiology, neuroscience, and histology laboratories using largely recycled materials and affordable electrical parts. The resulting systems are comparable to commercially available devices but at a fraction of the cost. The peristaltic perfusion pump has an adjustable flow rate suitable for the whole-body perfusion of rats and mice. Testing in rodents confirmed that the pump operated conveniently and consistently, yielding high-quality tissue perfusion and fixation. The rotarod worked flawlessly in behavioral studies with live mice, yielding speed, torque, acceleration and timing comparable to commercially-available devices. Collectively, the findings indicate that the purpose-built peristaltic perfusion pump and rotarod can be used in research laboratories as cost-effective alternatives to comparable but costly commercial devices.

Using Black Carrot Extracts as an Alternative Biological Dye for Tissue Staining

Background: Tissue staining is pivotal in histology and histopathology, shouldering a noteworthy role in identifying and classifying tissues and diseases. Due to their non-production of toxic effluents, the utilization of plant-based dyes aligns harmoniously with environmental sustainability and the well-being of laboratory personnel and the general public. Furthermore, this approach is highly cost-effective, further enhancing its appeal. Objectives: This research study explored the feasibility of staining various tissues in mice, such as the liver, kidney, intestine, and cartilage, utilizing a dye extracted from black carrots. Methods: An ethanol extract of 200 g of fresh black carrots (Daucus carota L.) was prepared using 95% ethanol saturated with two different solvents in 200 mL of distilled water. Subsequently, the prepared sections of mice tissue were immersed in the extracted dye solution for 20 minutes, followed by assessment using a light microscope. Hematoxylin-eosin staining was used as a control. Results: The dye extracted from the black carrot using alum and acetic acid successfully stained the cartilage, kidney, intestine, and liver tissues, giving them a bluish-gray coloration. Phytochemical screening further confirmed the presence of anthocyanins in the black carrot extract. Conclusion: The dye derived from black carrots exhibits natural tissue staining capabilities, making it an alternative to hematoxylin-eosin in histology and histopathology laboratories.

Frequency of Prostatic Adenocarcinoma in Transurethral Resection of Prostatectomy Done for Benign prostatic Enlargement and Correlation with Serum Level of PSA

Background: Around the world, transurethral resection of the prostate, or TURP, is the most often used surgical procedure for treating benign prostatic hyperplasia (BPH). The current study is designed to evaluate the Frequency of prostatic Adenocarcinoma in transurethral resection of prostatectomy and its correlation with serum levels of PSA. Methods: The Retrospective study was conducted in the Histopathology Lab of Dr. Akbar Niazi Teaching Hospital Islamabad which is an PMDC-approved and ISO-9001-certified hospital. The data for this study was obtained by including consecutive cases of transurethral resection prostatectomy received for analysis in the histopathology lab during the study period. The data was retrieved from Histopathology record files. The slides were viewed and the diagnoses were confirmed. The patient’s serum PSA levels were retrieved from pre-operation hospital medical records. The Patients who presented to the histology lab for diagnosis were reassessed using a Questionnaire based on Performa divided into different sections such as socio-demographic data, reasons, History of Diseases, PSA level, Age, and complications. The collected data was analyzed using SPSS Version 21. Results: In 53 patients 11 were of Prostatic Adenocarcinoma, 14 were benign prostatic hyperplasia and 28 were prostatitis. with number and percentage. Prostate Specific Antigen value was different in patients. The highest reported value was 28ng/ml. The mean was 2.68 ng/ml. Most cases were present between the age group of 50-60 years with 32.1% Prostatic adenocarcinoma frequency was higher in the older age group levels above 4ng/ml were seen in prostatitis and BPH. Conversely, there were cases of prostatic adenocarcinoma with less than/ml PSA levels Conclusion: PSA levels were raised, above 4ng/ml in 8 cases while low in 3 cases of Prostatic adenocarcinoma. PSA levels were also raised in a case of prostatitis and two cases of BPH. We conclude that PSA levels although suggestive are not entirely specific for prostatic adenocarcinoma.

Survey of NAACLS accredited histotechnology programs in the United States

ABSTRACT Histotechnology educational programs are accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) and currently number fewer than 50 in the United States which contributes to the shortages of laboratory personnel. A survey tool designed with REDCap software was distributed to all programs identified on the NAACLS website and consisted of three parts: a) program information, b) facility information, and c) challenges. Programs are located primarily in large urban centers where populations are most concentrated. The median class size was 6 which may explain the excellent student outcomes to include 96% graduation rates and 90.7% board of registry examination pass rates. Overall, programs had ample equipment, funding, and administrative support. Costs to attend the programs were relatively low (<$3,000 per semester) for over half of the programs. However, due to the small number of accredited education programs across the US, potential students do not often have access to an institution in their area. The programs indicated that the most common challenge was recruitment of adequate high-quality candidates which may explain, in part, the persistent shortage of personnel in the histology laboratory.

The Effects of Different Storage Conditions on Leukocytes in Human Breast Milk.

Breast milk is the best baby food because it contains various nutrients and important factors for the baby's immune system, including leukocytes. This study aimed to determine the effects on morphology, number of cells and breast milk leukocytes count of various ways of storing breast milk based on different temperatures and storage durations. This study was conducted at the Biochemistry Laboratory, Integrated Laboratory and the Histology Laboratory, Universitas Indonesia, Jakarta, Indonesia from September 2022 to February 2023. Transitional breast milk samples from 7 breastfeeding mothers were utilised in the study. A total of 50 mL was divided into 4 tubes of 12.5 mL each and treated based on temperature, storage time and method of thawing frozen breast milk based on the Centers for Disease Control and Prevention's (CDC) recommendations for breast milk storage. The breast milk cells were isolated to calculate the cell number and leukocyte population. Subsequently, the breast milk cells were stained with haematoxylin and eosin to analyse the number and morphology of leukocytes. The findings showed a significant decrease in the breast milk's total number and population and changes in the morphology of breast milk leukocytes after storage. This study indicates that CDC storage recommendations do not affect the quantity of the CD45+ leukocyte population; however, there is a decrease in the total number of leukocytes and alterations in their microscopic morphology. Thus, additional research is recommended to determine whether these modifications influence the function of the breast milk cells.

Prognostic Value of BAP1 Protein Expression in Uveal Melanoma.

The prognostic value of the traditional pathologic parameters that form part of the American Joint Committee on Cancer staging system and genetic classifications using monosomy chromosome 3 and structural alterations in chromosome 8 are well established and are part of the diagnostic workup of uveal melanoma (UM). However, it has not been fully clarified whether nuclear protein expression of the tumor suppressor gene BAP1 (nBAP1) by immunohistochemistry alone is as powerful a predictor of overall survival (OS) and/or disease-specific survival (DSS) as chromosome analysis. The protein expression of nBAP1 was evaluated in a retrospective cohort study of 308 consecutive patients treated by primary enucleation between January 1974 and December 2022. We correlated clinical, pathologic, and cytogenetic characteristics to identify the best prognostic indicators for OS and DSS. Loss of nBAP1 was detected in 144/308 (47%) of patients. Loss of nBAP1 expression was significantly associated with poor survival. In patients with disomy chromosome 3, nBAP1 negative is significantly associated with poorer OS but not DSS. We observed that older age (>63 years), presence of metastasis, and nBAP1 negative remained independent prognostic factors in multivariate analysis. nBAP1 protein expression proved to be a more reliable prognostic indicator for OS than the American Joint Committee on Cancer staging, M3 status, or The Cancer Genome Atlas classification in this cohort. This study provides support for accurate prognostication of UM patients in routine histology laboratories by immunohistochemistry for nBAP1 alone.

Histochemical and morphological evaluation of a glyoxal acid-free fixative

ABSTRACT The application of most chemical fixatives, such as formalin, in the anatomic pathology laboratory requires safety training and hazardous chemical monitoring due to the toxicity and health risks associated with their use. Consequently, the use of formalin has been banned in most applications in Europe; the primary exception is its use in the histology laboratory in lieu of a suitable and safer alternative. Glyoxal based solutions, several of which are available commercially, are the most promising alternative fixatives, because they are based on a mechanism of fixation similar to that of formalin. Unlike formalin, however, glyoxal based solutions do not dissociate from water and therefore do not require ventilation measures such as a fume hood. A primary barrier to the adoption of commercially available glyoxal based solutions is their low pH, which can produce undesirable morphological and antigenic tissue alterations; however, a recently available neutral pH glyoxal product (glyoxal acid free) (GAF) has been developed to mitigate the challenges of low pH. We compared the morphology and histochemistry among tissues fixed in 10% neutral buffered formalin, a commercially available acidic glyoxal product (Prefer), and GAF. Tissues fixed in formalin and Prefer exhibited similar morphology and staining properties; tissues fixed with 2% GAF exhibited deleterious effects.

Cerebral Histopathology in Acute Toxicity Test of Curcuma Zedoria

This research aims to determine the effect of the acute toxicity test of white turmeric extract (Curcuma zedoaria) on the brain organ. This research is experimental research with a Post Test Only Control Group Design. This research was conducted at the Pharmacy and Histology Laboratory. Faculty of Medicine. University of North Sumatra. The research was carried out from January to March 2023. The population in this research involved male white rats (Rattus norvegicus). The results of the acute toxicity test of white turmeric extract for 14 days showed no signs of toxicity or death in rats given the smallest to largest doses, resulting in an apparent LD50 value of white turmeric extract is &gt;2 g/kgBW, and is classified in the practically non-toxic category. Rats that received white turmeric extract showed movement or activity, appearing more energetic by the end of the second week with increasing doses. Histopathological examination of the brain in the acute toxicity test revealed minimal changes, such as edema and congestion in line with increasing doses.

Glycogen Storage Disease Type III Presenting as Recurrent Seizure Disorder in a Second Twin: A Case Report

Glycogen storage diseases (GSDs) are a group of genetic autosomal recessive metabolic disorders resulting from deficiencies of enzymes of glycogen metabolism occurring in the liver, muscles or kidneys. Various types and sub-types exist based on genetic classification presenting with symptoms and signs of hypoglycaemia, hepatomegaly and myopathy depending on severity, and age of onset. A high index of suspicion is required for the diagnosis of GSDs. An eighteen-month-old girl who was apparently healthy with normal development was without any abnormality until about 12 months of age when she had the first episode of afebrile seizure which was treated with sodium valproate but continued to have occasional seizures. She had a status seizure, which was only aborted with a glucose infusion. Intra-ictal incident glucose level was 1.4mmol/L. Biochemical investigation revealed deranged liver enzymes, normal serum cortisol, C-peptide and insulin. Liver histology showed features consistent with GSD III and diagnosis of glycogen storage disease type III was made based on the liver histology and other supportive laboratory features. Following dietary management, the child responded very well, was seizure-free and off anticonvulsant therapy. This case highlights the occurrence of symptomatic seizures due to factors other than epilepsy.

Evaluation of A Computer-Aided Detection Software for Prostate Cancer Prediction: Excellent Diagnostic Accuracy Independent of Preanalytical Factors

Prostate cancer (PCa) is the most common noncutaneous cancer in men in the Western world. In addition to accurate diagnosis, Gleason grading and tumor volume estimates are critical for patient management. Computer-aided detection (CADe) software can be used to facilitate the diagnosis and improve the diagnostic accuracy and reporting consistency. However, preanalytical factors such as fixation and staining of prostate biopsy specimens and whole slide images (WSI) on scanners can vary significantly between pathology laboratories and may, therefore, impact the quality of WSI and utility of CADe algorithms. We evaluated the performance of a CADe software in predicting PCa on WSIs of prostate biopsy specimens and focused on whether there were any significant differences in image quality between WSIs obtained on different scanners and specimens from different histopathology laboratories. Thirty prostate biopsy specimens from 2 histopathology laboratories in the United States were included in this study. The hematoxylin and eosin slides of the biopsy specimens were scanned on 3 scanners, generating 90 WSIs. These WSIs were then analyzed using a CADe software (INIFY Prostate, Algorithm), which identified and annotated all areas suspicious for PCa and calculated the tumor volume (percentage area of the biopsy core involved). Study pathologists then reviewed the Algorithm’s annotations and tumor volume calculation to confirm the diagnosis and identify benign glands that were misclassified as cancer (false positive) and cancer glands that were misclassified as benign (false negative). The CADe software worked equally well on WSIs from all 3 scanners and from both laboratories, with similar sensitivity and specificity. The overall sensitivity was 99.4%, and specificity was 97%. The percentage of suspicious cancer areas calculated by the Algorithm was similar for all 3 scanners. For WSIs with small foci of cancer (<1 mm), the Algorithm identified all cancer glands (sensitivity, 100%). Preanalytical factors had no significant impact on whole slide imaging and subsequent application of a CADe software. Prediction accuracy could potentially be further improved by processing biopsy specimens in a centralized histology laboratory and training the Algorithm on WSIs from the same laboratory in order to minimize variations in preanalytical factors and optimize the diagnostic performance of the Algorithm.

Regeneration of Buccal Wall Defects after Tooth Extraction with Biphasic Calcium Phosphate in Injectable Form vs. Bovine Xenograft: A Randomized Controlled Clinical Trial.

Bone healing after tooth extraction may be affected by defects of the alveolus buccal wall, such as fenestrations and dehiscences. Therefore, to minimize dimensional changes it is advisable to perform alveolar ridge preservation after tooth extractions. Different biomaterials are used for this purpose. The aim of this study was to investigate the qualitative and quantitative histological changes in human biopsies taken after 6 months of healing of extraction sockets with buccal wall defects. For this purpose, the defects of 36 patients (18 per group) were treated with injectable biphasic calcium phosphate (I-BCP) or bovine xenograft (BX) after extraction. After six months of healing, biopsies were taken and proceeded to the histology laboratory. No evidence of an inflammatory response of the tissue was observed in the biopsies of either group, and the newly formed bone (NB) was in close contact with the remaining biomaterial (BM). The histomorphometric results showed that there was no statistically significant difference between the groups in the mean percentage of NB (p = 0.854), BM (p = 0.129), and soft tissue (p = 0.094). To conclude, both biomaterials exhibited osteoconductivity and biocompatibility and achieved satisfactory bone regeneration of buccal wall defects after tooth extraction.

EVALUATION OF THE EFFICACY OF VARIOUS XYLENE SUBSTITUTES AS A CLEARING AGENT IN TISSUE PROCESSING: A COMPARATIVE STUDY

Conventional tissue processing is still remains the gold standard. Tissue processing is a physical process that involves chemical solutions reacting with biological specimens. The main purpose of tissue processing is to embed the tissue in solid medium, firm enough to support the tissue and give it sufficient rigidity to enable thin sections to be cut and soft enough not to damage the knife or tissue. For any tissue specimen to undergo diagnosis, it has to follow procedural steps such as fixation, dehydration, clearing, impregnation, embedding, sectioning and staining. Clearing is the process of replacing the dehydrating solution (which is not miscible with the embedding medium) with a substance which will be miscible with alcohol and the embedding medium. The most commonly used clearing agent is xylene. It has excellent clearing capabilities. But it cause unwelcome effects on the various system of the human body like on skin, eyes, nervous system, blood, liver and kidneys as reported by Kandyala et al. In the present study, we evaluate the efficacy of three materials like Kerosene, Turpentine and Olive oil other than xylene which are substitutes as a clearing agent in tissue processing and observe their effect on staining characteristics and compare with xylene. It is better promoting to eliminate xylene from the histology laboratory is a duty of those who are in decision-making positions. Since our study was limited in sample size and there are very less studies comparing all the four chemicals in clearing agent, it is recommended to carry this study in large scale with addition of different substitutes and analyzing with multiple observers.

Distribution of human papillomaviruses (HPV) by geographical area and affected organ in Greece

Introduction: Even today we do not have a comprehensive picture of the impact of the virus in Greece and its location at various anatomical sites. Aim: The aim of the study was to investigate and record the impact of HPV infection in the Greek population with emphasis on the affected organ/system. Methodology: The data of the tissue bank of the histology and embryology laboratory of the Medical School of Athens was utilized. It includes cases with the following characteristics: a) they are fully characterized in terms of HPV infection (complete subtyping of the virus), b) they belong to benign and malignant neoplasms of various organs with complete histopathological assessment, c) have been collected in at least the last decade d) have accompanying clinical and demographic data and e) their origin covers the entire Prefecture of Attica and a wide age range. Results: In 60% of the samples no type of HPV was detected, while in 12%, low-risk types were detected and in 28% high-risk types. Women had a higher rate of infection with different types of HPV and were at higher risk, with HPV types 16 &amp; 18 being more common than men, who were more likely to have HPV 6 &amp; HPV 11 types. Infection with a high-risk type occurred in 23.4% of women versus 0.3% of men. The most common type in cervical secretions was HPV 16 (14% and 10.3% respectively), followed by HPV 18 with rates of 7.4% and 10.3% respectively. Regarding skin, HPV types 16 &amp; 18 were found with the same frequency (11.1%). In the perineum-rectum, the types of HPV6 &amp; 11 predominated (20.7%), followed by HPV 16 &amp; 18. Conclusion: The present study contributes to the further investigation of the prevalence of HPV in Greece, with emphasis on more types of HPV and more anatomical sites, providing information on the male population. It will help update public health planning, detect and prevent HPV-related cancers in both sexes in Greece

Ultrasound Findings of Suspected Breast Cancer Lesions in Females Accessing Breast Ultrasound Services in Selected Hospitals in Lusaka, Zambia

Background: Breast cancer is the most common malignancy among women in Zambia. Ultrasound can be a useful tool for early diagnosis of breast cancer based on the breast lesions’ features. However, an overlap in the ultrasound features of malignant and benign breast tumours has been noticed together with a paucity of information on the ultrasound features that are more suggestive of breast cancer. Objective: The purpose of this study was to identify ultrasound features of suspected breast cancer lesions which may assist in ascertaining a high breast cancer or benign breast disease suspicion index, that may be used to prioritise patients requiring further and urgent management for breast cancer. Methods: Systematic random sampling was used for the selection of participants in this study. The selected patients first underwent an ultrasound scan in the Ultrasound department to obtain the breast lesion ultrasound features. The histology results for the same patients were then obtained from the University Teaching Hospital (UTH) histology laboratory or the histology report filed in the patient’s medical file. Results: Irregular shape of breast lesions, vertical orientation of breast lesions, hypoechogenicity of breast lesions, complex echo pattern of breast lesions, irregular or spiculated margin contours of breast lesions, compression of breast lesion surrounding tissue, absence of hyperechogenic spots in breast lesions and a breast lesion boundary with neither a hyperechoic halo nor thin capsule (None) were found to be associated with breast cancer. No breast lesion showed less than 3 ultrasound features suspicious for breast cancer. Hyperechoic spots in breast lesions were found to be associated with non-cancerous breast lesions. Conclusion: Low-resource countries, such as Zambia, where access to imaging diagnostic equipment such as Mammography and Magnetic Resonance Imaging machines (MRI), and histology examinations are scarce, the preceding ultrasound findings .......