title: Wilms tumour in Malawi: surgical staging to stratify postoperative chemotherapy?
abstract: BACKGROUND
  Wilms tumour postoperative chemotherapy is ideally stratified according to the pathologist's assessment of tumour stage and risk classification (tumour type). In sub-Saharan Africa results are often not available in time to influence therapy and in Malawi surgical staging has been used to stratify postoperative chemotherapy. Here we compare the results from surgical and both local pathology and central pathology review.
  
  
  METHODS
  Children diagnosed with a Wilms tumour in Blantyre, Malawi between 2007 and 2011 were included if they had a nephrectomy and the pathology slides were available. All tumour specimens were assessed in three different ways: the local surgeon documented the surgical stage of the tumour, and the risk classification and pathology stage were assessed both by the local pathologist and by a SIOP central review pathologist in Europe.
  
  
  RESULTS
  Fifty patients had complete data available and were included in the analyses. Tumour risk classification differed between the local and central pathology review in only two patients (4%). Using central pathology review as the gold standard 60% of patients received the correct postoperative chemotherapy treatment based on surgical staging and 84% based on the local pathology stage and risk classification.
  
  
  CONCLUSIONS
  Local pathology capacity building is needed to enable timely assessment and reporting.
authors.affiliation: Department of Surgery, College of Medicine, Blantyre, Malawi.
authors.forename: Eric
authors.initials: E
authors.lastname: Borgstein
authors.forename: Steve
authors.initials: S
authors.lastname: Kamiza
authors.forename: Gordan
authors.initials: G
authors.lastname: Vujanic
authors.forename: Dalida
authors.initials: D
authors.lastname: Pidini
authors.forename: Simon
authors.initials: S
authors.lastname: Bailey
authors.forename: Tamiwe
authors.initials: T
authors.lastname: Tomoka
authors.forename: Kondwani
authors.initials: K
authors.lastname: Banda
authors.forename: Gertjan
authors.initials: G
authors.lastname: Kaspers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Molyneux
authors.forename: Trijn
authors.initials: T
authors.lastname: Israels
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D008295:Malawi; D008297:Male; D009367:Neoplasm Staging; D009392:Nephrectomy; D011182:Postoperative Care; D011379:Prognosis; D014750:Vincristine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin
keywords: Africa; Wilms tumour; adapted treatment regimens; low income countries; nephroblastoma; pathology; peer review; postoperative chemotherapy; stratification