Utilization of fine needle aspiration cytology at Kamuzu central hospital

Abstract

BackgroundFine needle aspiration cytology (FNAC) has been widely accepted to be a safe, accurate, prompt and inexpensive procedure for diagnosis of both neoplastic and infectious diseases in adult and pediatric populations. Despite its value for diagnosis, FNAC is underutilized in resource limited countries. We reviewed the utilization of FNAC after it was introduced at Kamuzu Central Hospital (KCH).MethodsA retrospective review of all FNAC performed at KCH laboratory during the period of January 2012 to July 2014 was conducted using an electronic database from KCH laboratory. We evaluated factors associated with a diagnostic sample using multivariate logistic regression model.Results750 FNAC were reviewed from 722 patients: 56.9% were adults >15 years and 54% were female. The number of FNAC increased annually from 56 (2012) to 379 (2013) to 315 (up to July 2014). Of 750 FNAC, 56.4% were performed by non-pathologists. The most common sites were lymph nodes (38.1%), abdomen (25.8%), breast (16.3%), and head & neck (15.7%). Most of the samples (77.6%) were diagnostic. FNAC was more likely to be diagnostic if performed by pathologists versus non-pathologists (OR 1.78, 95% CI 1.20–2.64), in 2013 compared to 2012 (OR 1.95, 95% CI 1.05–3.56), or performed on a deep lesion versus a subcutaneous lesion (OR 1.71, 95% CI 1.15–2.5), or if samples were taken from the head and neck (OR 2.4, 95% CI: 1.39–4.39), and abdomen (OR 2.66, 95%CI1.59–4.42) compared to those from the lymph nodes. The odds of a diagnostic test did not differ significantly according to gender, HIV status, or age groups.ConclusionMost FNACs successfully diagnosed the presence or absence of disease, with substantial improvements over time. However, training for non-pathologists may facilitate more diagnostic results.

Analysis of the causes of cervical lymphadenopathy using fine-needle aspiration cytology combining cell block in Chinese patients with and without HIV infection

“…Undesirable aspirates were due to insufficiently trained cytopathologists and poor handling of the aspirated material [28]. It has been reported that FNAC has more diagnostic accuracy when performed by an experienced pathologist, in comparison to the other clinicians [1]. This finding is in accordance with other studies that have shown that the success of FNAC highly depends on the training and experience of the personnel conducting the procedure [28,29].…”

“…FNAC is an excellent diagnostic tool for HIV-positive patients with lymphadenopathy. It is a routine examination that is cheap, quick, safe, free of complications, well tolerated by the patient, and highly accurate [1]. The smear can be evaluated immediately and the procedure can be repeated several times to obtain further materials for diagnosis or special stains.…”

Analysis of the causes of cervical lymphadenopathy using Fine-Needle Aspiration Cytology combining cell block in Chinese Patients with and without HIV infection

“…FNAC is an excellent diagnostic tool for HIV-positive patients with lymphadenopathy. It is a routine examination that is cheap, quick, safe, free of complications, well tolerated by the patient, and highly accurate [1].…”

Fine needle aspiration biopsy in low‐ and middle‐income countries

“…Overall, this study supports the utility of FNAB in resource-limited settings and highlights the importance of training non-pathologists to perform the procedure effectively. 22…”