An audit and review of the histopathologic reporting of retinoblastoma specimens at Kenyatta National Hospital
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Background: Post-enucleation retinoblastoma treatment relies heavily on the outcome of adequate gross and microscopic reporting of surgical ocular specimens by histopathologists. As such, histopathology reports for retinoblastoma specimens should include all prognostic and predictive factors to be of any value to the clinicians. This study was carried out to evaluate retrospectively and prospectively the histopathological reporting of retinoblastoma specimens. Objective: To audit histopathology request forms and reports, and assess the completeness of histopathology reporting of retinoblastoma specimens between January 2000 and October 2007. Design: A laboratory-based retrospective and prospective descriptive study. Setting: The study was carried out at the KNH Histopathology Laboratory. Subjects: One hundred and two ocular specimens clinically suspected and histologically verified to contain retinoblastoma were studied. Materials and Methods: All consecutive retinoblastoma histopathology request forms and reports issued between January 2000 and October 2007 were retrieved from archives. Specimen blocks were retrieved and microscopic sections prepared and reviewed. Findings, including staging were compared with those in the initial pathology reports. Retinoblastoma specimens submitted during the study period were reported. Data analysis was done using standard statistical tests (chi-square and kappa statistics). Results: One hundred and five (105) retinoblastoma specimens were studied. Three were excluded from the study due to incorrect initial diagnosis. Ninety three (93) specimens were studied retrospectively and nine (9) prospectively. Of the retrospective cases, 55 were obtained from male and 36 from female patients (male to female ratio was 1.5:1). The mean age was 32.8 months, and age range 3 months to 120 months. Clinical information was inadequate in 22 (23.6%) request forms. Documentation of gross findings by histopathologists was found to be inadequate in 71 (76.3%) audited reports. Documentation of important prognostic histopathological features was omitted in 33 (35.5%) initial pathology reports. An audit and review of the hislopothologic reporting of retinoblastoma specimens ct KNH 1 Conclusions: Ophthalmologists do not adequately fill pathology request forms for retinoblastoma specimens. Histopathologists do not adequately document gross examination findings of retinoblastoma specimens, and reporting of prognostically important histopathologic features of retinoblastoma is frequently incomplete. The level of agreement between the initial histopathological findings and those obtained after review of the sections was low, indicating significant intra- and inter-observer variations among the histopathologists.