Audit of Histopathological Processes of Retinoblastoma Collaborative Laboratory at the Dental School University of Nairobi

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.