Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana
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.
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Posted 03 Jan, 2020
On 30 Dec, 2019
On 19 Dec, 2019
On 19 Dec, 2019
On 18 Dec, 2019
On 17 Dec, 2019
On 18 Dec, 2019
On 16 Nov, 2019
Received 16 Nov, 2019
Received 16 Nov, 2019
On 15 Nov, 2019
On 15 Nov, 2019
On 15 Nov, 2019
Invitations sent on 15 Nov, 2019
On 15 Nov, 2019
On 21 Oct, 2019
Received 16 Oct, 2019
On 26 Jul, 2019
Received 13 Jul, 2019
On 03 Jul, 2019
Invitations sent on 02 Jul, 2019
On 28 Jun, 2019
On 28 Jun, 2019
On 27 Jun, 2019
On 25 May, 2019
Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana
Posted 03 Jan, 2020
On 30 Dec, 2019
On 19 Dec, 2019
On 19 Dec, 2019
On 18 Dec, 2019
On 17 Dec, 2019
On 18 Dec, 2019
On 16 Nov, 2019
Received 16 Nov, 2019
Received 16 Nov, 2019
On 15 Nov, 2019
On 15 Nov, 2019
On 15 Nov, 2019
Invitations sent on 15 Nov, 2019
On 15 Nov, 2019
On 21 Oct, 2019
Received 16 Oct, 2019
On 26 Jul, 2019
Received 13 Jul, 2019
On 03 Jul, 2019
Invitations sent on 02 Jul, 2019
On 28 Jun, 2019
On 28 Jun, 2019
On 27 Jun, 2019
On 25 May, 2019
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