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Wilms tumour in Malawi: Surgical staging to stratify postoperative chemotherapy?
Author(s) -
Borgstein Eric,
Kamiza Steve,
Vujanic Gordan,
Pidini Dalida,
Bailey Simon,
Tomoka Tamiwe,
Banda Kondwani,
Kaspers Gertjan,
Molyneux Elizabeth,
Israels Trijn
Publication year - 2014
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25138
Subject(s) - medicine , surgical pathology , stage (stratigraphy) , wilms tumour , wilms' tumor , nephrectomy , chemotherapy , anatomical pathology , gold standard (test) , pathology , general surgery , radiology , surgery , kidney , immunohistochemistry , paleontology , biology
Background Wilms tumour postoperative chemotherapy is ideally stratified according to the pathologist's assessment of tumour stage and risk classification (tumour type). In sub‐Saharan Africa results are often not available in time to influence therapy and in Malawi surgical staging has been used to stratify postoperative chemotherapy. Here we compare the results from surgical and both local pathology and central pathology review. Procedure Children diagnosed with a Wilms tumour in Blantyre, Malawi between 2007 and 2011 were included if they had a nephrectomy and the pathology slides were available. All tumour specimens were assessed in three different ways: the local surgeon documented the surgical stage of the tumour, and the risk classification and pathology stage were assessed both by the local pathologist and by a SIOP central review pathologist in Europe. Results Fifty patients had complete data available and were included in the analyses. Tumour risk classification differed between the local and central pathology review in only two patients (4%). Using central pathology review as the gold standard 60% of patients received the correct postoperative chemotherapy treatment based on surgical staging and 84% based on the local pathology stage and risk classification. Conclusion Local pathology capacity building is needed to enable timely assessment and reporting. Pediatr Blood Cancer 2014;61:2180–2184. © 2014 Wiley Periodicals, Inc.