Cytomorphological Spectrum of Diagnoses From Bone Marrow Preparation and Fine Needle Aspiration in Coast and Nyeri Level 5 Hospitals, Kenya

Abstract

Background: Bone marrow examination and fine needle aspiration biopsy are useful tools for pathological diagnosis of malignancies and other diseases These procedures are cost-effective, minimally invasive, reliable, fast and well tolerated by patients as they have minimal complications. These two techniques are under-utilized by medical practitioners universally due to lack of competence in performing these procedures. Lack of consumables also lead to their under-utilization for optimal screening and diagnosis. This study set out to document the spectra of diagnoses in two level 5 hospitals in Kenya after implementation of a skills-transfer initiative on performing bone marrow evaluation, fine needle aspiration and sample preparation to increase access and to improve diagnosis. The study was part of a larger project working to improve cancer diagnosis by training medical officers and laboratory technologists on procedure performance and technical competence. Objective: To document the cytomorphological spectrum of diagnoses made using two techniques: - bone marrow examination and fine needle aspiration at 2 level 5 hospitals in Kenya (Coast and Nyeri Provincial General Hospitals) in an operational initiative to improve cancer diagnosis. Materials and methods: This was a retrospective cross-sectional descriptive study. The study was carried out in Coast and Nyeri level 5 hospitals between January 2013 and December 2016. Bone marrow evaluation (BME) and Fine needle aspiration (FNA) reports from January 2013 to December 2016 were included in the study. A skill transfer operational initiative was implemented in January 2016 to December 2016 of the study. Processed BME and FNA slides were assessed by the principal investigator and three pathologists (supervisors) as part of patient management and results recorded in the data collection book. The reports were examined and findings recorded in a standard proforma including age, sex, relevant investigation and cytomorphological diagnosis made. Data was then analysed to determine the frequencies of different diagnoses made from the two techniques. Results: The study included 877 FNAs and 75 BMEs. There was a varied age distribution for both the BMA and FNA patients ranging from 2 months to 81 years. The male: female ratio of BMEs reported was 2:1. The 30-39 age bracket contributed to the highest number of BMAs reported ,17.3% (n=75). The mean age for BMEs at Coast level 5 was 32.9 while at Nyeri level xiii 5 it was 41.9. Marrows with reactive changes accounted for most predominant non-malignant haematological diagnosis, Coast 18 (61%) and Nyeri 11 (39%). Acute leukemias were the commonest haematological malignancies reported in both level 5 hospitals 6 (50%) each. The male: female ratio of FNAs reported was 1:2.5 and the highest number of FNAs reported were from the 20-29 age bracket. Soft tissue lesions were the most frequent diagnoses made in both level 5 hospitals, Nyeri 148 (52%) and Coast 136 (48%) out of 877, followed by breast lesions which were more frequently reported in Nyeri 166(60%) and 112 (40%) at Coast level 5 hospital. Conclusion The spectrum of diagnoses was similar in the two regions and reflect the morbidity patterns described for these population by the Kenya Demographic Health Surveys (KDHS). Marrows showing reactive changes were the commonest non-malignant findings while acute leukemias were the commonest haematological malignancies in the two hospitals. Lipomas and fibroadenomas were more frequently reported in Nyeri level 5 hospital than Coast level 5 hospital. There were more malignant conditions picked in Nyeri level 5 hospital compared to Coast level 5 hospital using the two diagnostic techniques. Recommendations Similar initiatives can be done in other sites to define disease trends as this will help with documentation of disease types and burdens in the country. Consecutive reviews to determine the long-term impact of the intervention on cancer diagnosis using BMEs and FNAs in the two hospitals should be done.