title: Biopsy case mix and diagnostic yield at a Malawian central hospital.
abstract: 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.
authors.affiliation: Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.
authors.forename: P
authors.initials: P
authors.lastname: Mtonga
authors.affiliation: Consultant Clinical Oncologist QECH, University of Malawi, College of Medicine Clinical lecturer.
authors.forename: L
authors.initials: L
authors.lastname: Masamba
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Milner
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: L N
authors.initials: LN
authors.lastname: Shulman
authors.affiliation: Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.
authors.forename: R
authors.initials: R
authors.lastname: Nyirenda
authors.affiliation: Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi ; Consultant Clinical Oncologist QECH, University of Malawi, College of Medicine Clinical lecturer.
authors.forename: K
authors.initials: K
authors.lastname: Mwafulirwa
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000473:pathology; D055815:Young Adult