See the published version of this article at BMC Cancer.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana
Lars Hviid
Københavns Universitet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1698-4927
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cancer.
Endemic Burkitt lymphoma (eBL) is an aggressive B-cell lymphoma, which is a common childhood cancer in areas with intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is thus generally based on clinical assessment and morphological examination of tumour biopsies or fine-needle aspirates (FNAs). The purpose of the present study was to assess the accuracy of eBL diagnosis at two tertiary hospitals in Ghana. To that end, we studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) biopsies from Ghanaian patients originally diagnosed as eBL (N=55) or non-eBL (N=56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C-MYC immunohistochemistry, and fluorescence in situ hybridisation (FISH) analysis of c-myc rearrangements We found a good correlation between original diagnosis and subsequent retrospective assessment, particularly for FNA samples. However, evidence of intact c-myc genes and normal C-MYC expression in samples from some patients originally diagnosed as eBL indicates that morphological assessment alone can lead to eBL over-diagnosis in our study area. In addition, several FFPE samples could not be assessed retrospectively, due to poor sample quality. Therefore, the simpler FNA method of obtaining tumour material is preferable, particularly when careful processing of biopsy specimens cannot be guaranteed. We conclude that the accuracy of eBL diagnostic tools available in Ghana is generally adequate, but could be improved by implementation of additional pathology laboratory investigations. Improved attention to adequate preservation of archival samples is recommended.
Keywords
Endemic Burkitt lymphoma; diagnostic accuracy; morphology, C MYC immunohistochemistry, c myc FISH
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 03 Jan, 2020
Published
On 30 Dec, 2019
No community comments so far
Submission checks complete
On 19 Dec, 2019
Editorial decision: Accept
On 19 Dec, 2019
Editor assigned
On 18 Dec, 2019
Editor invited
On 17 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 18 Dec, 2019
Reviewer #2 agreed
On 16 Nov, 2019
Review #2 received
Received 16 Nov, 2019
Review #1 received
Received 16 Nov, 2019
Submission checks complete
On 15 Nov, 2019
Editor invited
On 15 Nov, 2019
Editor assigned
On 15 Nov, 2019
Reviewers invited
Invitations sent on 15 Nov, 2019
Reviewer #1 agreed
On 15 Nov, 2019
No comments provided
Editorial decision: Major revision
On 21 Oct, 2019
Review #2 received
Received 16 Oct, 2019
Reviewer #2 agreed
On 26 Jul, 2019
Review #1 received
Received 13 Jul, 2019
Reviewer #1 agreed
On 03 Jul, 2019
Reviewers invited
Invitations sent on 02 Jul, 2019
Submission checks complete
On 28 Jun, 2019
Editor assigned
On 28 Jun, 2019
Editor invited
On 27 Jun, 2019
First submitted
On 25 May, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
This preprint is under consideration at BMC Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana
Lars Hviid
Københavns Universitet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1698-4927
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 03 Jan, 2020
Published
On 30 Dec, 2019
No community comments so far
Submission checks complete
On 19 Dec, 2019
Editorial decision: Accept
On 19 Dec, 2019
Editor assigned
On 18 Dec, 2019
Editor invited
On 17 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 18 Dec, 2019
Reviewer #2 agreed
On 16 Nov, 2019
Review #2 received
Received 16 Nov, 2019
Review #1 received
Received 16 Nov, 2019
Submission checks complete
On 15 Nov, 2019
Editor invited
On 15 Nov, 2019
Editor assigned
On 15 Nov, 2019
Reviewers invited
Invitations sent on 15 Nov, 2019
Reviewer #1 agreed
On 15 Nov, 2019
No comments provided
Editorial decision: Major revision
On 21 Oct, 2019
Review #2 received
Received 16 Oct, 2019
Reviewer #2 agreed
On 26 Jul, 2019
Review #1 received
Received 13 Jul, 2019
Reviewer #1 agreed
On 03 Jul, 2019
Reviewers invited
Invitations sent on 02 Jul, 2019
Submission checks complete
On 28 Jun, 2019
Editor assigned
On 28 Jun, 2019
Editor invited
On 27 Jun, 2019
First submitted
On 25 May, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cancer.
Endemic Burkitt lymphoma (eBL) is an aggressive B-cell lymphoma, which is a common childhood cancer in areas with intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is thus generally based on clinical assessment and morphological examination of tumour biopsies or fine-needle aspirates (FNAs). The purpose of the present study was to assess the accuracy of eBL diagnosis at two tertiary hospitals in Ghana. To that end, we studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) biopsies from Ghanaian patients originally diagnosed as eBL (N=55) or non-eBL (N=56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C-MYC immunohistochemistry, and fluorescence in situ hybridisation (FISH) analysis of c-myc rearrangements We found a good correlation between original diagnosis and subsequent retrospective assessment, particularly for FNA samples. However, evidence of intact c-myc genes and normal C-MYC expression in samples from some patients originally diagnosed as eBL indicates that morphological assessment alone can lead to eBL over-diagnosis in our study area. In addition, several FFPE samples could not be assessed retrospectively, due to poor sample quality. Therefore, the simpler FNA method of obtaining tumour material is preferable, particularly when careful processing of biopsy specimens cannot be guaranteed. We conclude that the accuracy of eBL diagnostic tools available in Ghana is generally adequate, but could be improved by implementation of additional pathology laboratory investigations. Improved attention to adequate preservation of archival samples is recommended.
Figure 1
Figure 2
Figure 3
Figure 4