dc.contributor.author | Midigo, Grace A | |
dc.date.accessioned | 2018-01-08T07:10:36Z | |
dc.date.available | 2018-01-08T07:10:36Z | |
dc.date.issued | 2017 | |
dc.identifier.uri | http://hdl.handle.net/11295/102270 | |
dc.description.abstract | Background
Retinoblastoma is the most common primary malignant intraocular tumor of childhood
presenting before age of 3 years. In Africa and other developing countries, mortality rates for
retinoblastoma patients are high (over 40%) due to diagnostic inefficiency and insufficiency.
Histopathology laboratories required to report on retinoblastoma pathology do not have
sufficient quality assurance measures which result in delayed diagnosis and therefore late
treatment of these patients in Africa. Although laboratories within the public health care
systems in Africa have adopted the World Health Organization AFRO (regional office of
Africa) step wise quality assurance program, its implementation in surgical pathology is
deficient. There is lack of data on quality assurance and therefore constraints in evidence
based laboratory medicine practice in Africa. Innovative implementation science initiatives
on quality assurance in African laboratories are therefore required. These would lead to
improvement of histopathology practice resulting in quality retinoblastoma diagnostics which
can be implemented in laboratories within the region.
Objectives
The main objective of this study was to conduct an audit of histopathology laboratory
processes of the Retinoblastoma Collaborative Laboratory at the University of Nairobi Dental
School.
Methodology
This was a retrospective study conducted at the Retinoblastoma Collaborative Laboratory at
the University of Nairobi School of Dental Sciences. Formalin fixed and paraffin embedded
tissues submitted for evaluation of suspected or confirmed diagnosis of retinoblastoma over a
period of three years (2012-2014) were included in the study. The requisition forms were
retrieved and examined for appropriate entries and gross descriptions. The corresponding
histopathological slides were retrieved from the archives and examined for integrity. They
were examined by two blinded pathologists. Data was recorded in proformas and analysed
using SPSS version 20. Demographic data was presented in tables, while dependent variables
was presented in charts. All statistical tests were performed at 5% level of significance (95 %
confidence level).
x
Results
One hundred and thirteen (113) cases of retinoblastoma were analyzed. Clinical history was
indicated in 101(89.4%) cases. Age in months was indicated in only 7 (6.2%) cases the rest
was indicated in years, mean age at presentation was 3 years. Date of surgery was indicated
in 108 (95.6%) of the cases. Documentation of the gross findings like specimen dimensions
was indicated in all cases. Documentation of important prognostic histopathologic features
(optic nerve involvement) was omitted in 16 cases (14.2%) initial reports. Ninety six cases
(85%) had adhered to College of American Pathologists Standard CAP) both in reporting and
processing.
Conclusion
Most of the ophthalmologists provide adequate clinical information for retinoblastoma
specimens. Gross examination by the pathologist is satisfactory. Reporting of prognostically
important histopathological features of retinoblastoma by pathologists was complete in the
majority of cases. Level of agreement between the initial histopatholgical findings and
audited reports was present (this was established using Kappa value), and agreement by
chance excluded. The laboratory has not fully adhered to college of American Pathologist
(CAP) standards recommended for eye processing specifically for retinoblastoma especially
in reporting tumor size and location after resection.
Recommendations
The laboratory should participate in external quality control program. Periodic audits should
also be integrated as part of the routine system to enable them maintain quality. The tool that
has been used to audit this laboratory can be used to audit other histopathology laboratories.
Continue use of Proforma to achieve 100% capture of clinical information, and 100%
adherence to CAP standards. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.rights | Attribution-NonCommercial-NoDerivs 3.0 United States | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/us/ | * |
dc.title | Audit of Histopathological Processes of Retinoblastoma Collaborative Laboratory at the Dental School University of Nairobi | en_US |
dc.type | Thesis | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |