Efficacy of an Intensive, Ultrasound-Guided Fine-Needle Aspiration Biopsy Training Workshop in Tanzania

Abstract

Background Fine-needle aspiration biopsy (FNAB) is a minimally invasive, cost-effective diagnostic tool that can be used in low-resource settings. However, adequacy and accuracy of FNAB is highly dependent on the skills of the operator and requires specialized training. Poor technique can preclude definitive diagnoses because of insufficient quality or quantity of FNAB samples. We evaluated the efficacy of an intensive training experience in Tanzania on improving ultrasound-guided FNAB techniques. Methods A 2-day workshop offered didactic lectures, demonstrations, and hands-on practicum on fundamentals of ultrasound imaging and FNAB technique. A prospective interventional study design was used with pre- and postintervention surveys and assessments to measure the effect of the workshop on specific skills related to slide smearing and ultrasound-guidance among participants. Results Twenty-six pathologists and radiologists, including trainees in each specialty, participated in the workshop. Pre- and postworkshop assessments demonstrated that most participants improved significantly in nearly all technical skills for slide smearing and ultrasound-guided FNAB. After the workshop, most participants demonstrated substantial improvements in ability to prepare the ultrasound equipment, measure the lesion in three dimensions by ultrasound, target lesions in one pass using both parallel and perpendicular approaches, and prepare high-quality aspirate smears. Conclusion An in-country 2-day workshop in Tanzania was efficacious in transferring basic skills in FNAB smear preparation and ultrasound-guided FNAB, resulting in skills enhancement among participating pathologists and radiologists. Although mastery of skills was not the goal of this short workshop, participants demonstrated proficiency in most technical elements after workshop completion, and the workshop generated interest among select participants to pursue additional intensive training in cytopathology.

Feasibility of Fine-Needle Aspiration Biopsy and Rapid On-Site Evaluation for Immediate Triage in Breast Cancer Screening in Tanzania

“… 21 Our group has also previously demonstrated that intensive workshops can be effective in developing skills essential for high-quality FNAB. 24 …”

Evaluating Estrogen Receptor Immunohistochemistry on Cell Blocks From Breast Cancer Patients in a Low-Resource Setting

“…[30][31][32] Studies have shown that various training models in cytopathology are effective, including fellowships, Webbased modules, and intensive workshops at our institution. 29,[33][34][35] However, the lack of systematic evaluation and standardization of the dozens of available cell block preparation methods limits the expansion of the use of the same in low-resource settings. [36][37][38][39] Strengthening the capacity of diagnostic cytopathology services by coupling them with ancillary tests such as cell blocks and IHC would also improve cancer care in Tanzania by shortening time and reducing the cost needed to achieve a definitive diagnosis.…”

Surgical applications of ultrasound use in low‐ and middle‐income countries: A systematic review

“…Furthermore, studies applying ultrasound have shown its utility for diagnosis and interventions in the neonatal setting for neurosurgical and cardiovascular surgical disease in LMICs 22,24,34–39 . Further novel applications of ultrasound in LMIC countries have been outlined in identifying and treating orthopedic, urology, thoracic surgery and surgical oncology pathophysiologies 40–50 …”

“…22,24,[34][35][36][37][38][39] Further novel applications of ultrasound in LMIC countries have been outlined in identifying and treating orthopedic, urology, thoracic surgery and surgical oncology pathophysiologies. [40][41][42][43][44][45][46][47][48][49][50] Limitations One limitation of the study was the overall level of evidence of studies included in the cohort, which was low. Case reports and retrospective reports predominated, and randomised control trials were the least common type of study performed during the study period.…”