Breast Cancer Reporting in Lagos, Nigeria: Implications for Training and Education in Africa

Abstract

PurposeTo assess the completeness and accuracy of breast cancer pathologic reporting in Nigeria.Materials and MethodsThe histologic parameters provided in breast cancer pathology reports at a large teaching hospital in Nigeria were assessed. The corresponding slides were reviewed after the United Kingdom Royal College of Pathologists guidelines, and results were compared.ResultsOut of 115 breast cancer cases, histologic type of breast carcinoma was concordant with the review type in 53.1% of cases and discordant in 46.9%. Grading was stated in 89.62% of cases, of which 50.5% were correctly graded, 35.8% were under-graded, and 8.5% were over-graded. Poor fixation and omission of the mitotic count were the main reasons for discordant grades. A comment on lymph node status was included in 40% of cases, and lymphovascular invasion was not commented on in 97.4% of cases. Only 26% of the tumors had hormone receptors and/or HER2 tested.ConclusionSome essential histologic parameters were absent from the histologic reports, and where present, a proportion were inaccurate. Attention to specimen fixation and method of grading and familiarity with uncommon breast cancer types are required; all can be facilitated by education and training. The use of a template/proforma is recommended to ensure cancer data set parameters are included in the pathology reports.

Adequacy of Pathologic Reports of Invasive Breast Cancer From Mastectomy Specimens at Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia

“…Audits of breast cancer pathology reports in Nigeria from 1999 to 2008 21 and from 2011 to 2013 22 also described incomplete reporting of recommended pathology information. Atanda and Atanda 21 noted that their laboratory was “at a stage comparable to that in most laboratories in Australia in 1995 before the release of specific recommendations for breast cancer reporting,” and Daramola et al 22 recommended adoption of synoptic reporting, stating that, “The use of proformas, with the inclusion of all the main parameters, would ensure adequacy of reports.”…”

“…Although quite a few studies have evaluated the completeness of breast cancer pathology reports in high-resource settings over the past three decades, 5 , 16 - 20 to the best of our knowledge, only two published reports described similar audits in sub-Saharan Africa. 21 , 22 Both of these studies identified substantial gaps in documentation of BHGI basic pathology information. 12 - 14 …”

Pathology and cancer in Africa

“…Although hard data are rare, several papers have examined some of the issues. A retrospective assessment of reports of breast carcinoma in the university teaching hospital in Lagos, Nigeria in 2016, showed that 60% of the reports did not mention lymph node status and 50% did not mention excision margins [6]. Hormone receptor was not stated in 74% cases.…”

Panoptic Overview of Triple-Negative Breast Cancer in Nigeria: Current Challenges and Promising Global Initiatives

“…Although Nigeria is one of the few African countries that have published guidelines, created by the Nigeria Breast Pathology Working Group in 2010, on standardized pathology reporting, these guidelines have not been adequately circulated or implemented in medical centers. Daramola et al 69 compared histologic parameters in pathology reports from a teaching hospital in Nigeria with the cancer data set of the Royal College of Pathologists in the United Kingdom to verify compliance and concordance. Almost half of the Nigerian BC cases examined were discordant with the Royal College of Pathologists, and roughly half of the cases were either undergraded or overgraded.…”