Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

Abstract

BackgroundCancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomesOver the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to a resource-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.ConclusionDevelopment of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

Novel biomarkers with promising benefits for diagnosis of cervical neoplasia: a systematic review

“…Moreover, studies have also demonstrated that p16/Ki-67 assay is able to identify accurately women at risk of precancerous lesions who may need to undergo further retesting at extended intervals [31]. Thus, with minimal training on the staining and interpretation protocol as demonstrated earlier in Slovenia and California [65][66][67], other cytotechnologists and cytopathologists in low and middle income countries (LMIC) would equally be able to examine and report correctly cases of cervical neoplasia given that similar trainings had also been piloted in Kenya and Malawi with good results [68]. Furthermore, considering the interobservers variability, and the need for repeat tests associated with Pap cytology, studies have equally shown that implementation of p16/Ki-67 assay would be more cost effective compared to the conventional Pap cytology [69].…”

“…The larger AUC and higher NPV correspond to a better diagnostic tool. Consequently, the reported test performance and the receiving operating characteristics curves implies that implementation of p16ink4a / ki-67 assay as a point of care test to be used specifically to triage HPV-DNA positive women at one visit with subsequent cryotherapy treatment is feasible, especially in regions with inadequate histology infrastructure such as Kenya [68,77]. This will reduce colposcopy referrals [78], and cushion high loss to follow-up associated with histology longer turnaround time [78,79].…”

Multi-Field-of-View Deep Learning Model Predicts Nonsmall Cell Lung Cancer Programmed Death-Ligand 1 Status from Whole-Slide Hematoxylin and Eosin Images

“…[171819] However, IHC staining can be limited by insufficient tissue samples, and in some settings, a lack of resources. [2021]…”

Audit of Oral Histopathology Service at a Nigerian Tertiary Institution over a 24-Year Period

“…Another reason is that facilities for immunohistochemical analysis in this centre existed at the latter half of the study period. Also, immunohistochemical stains are still limited and seldom used in most histopathology laboratories in Africa, due to various reasons highlighted in reports by Adeyi ( 4 ) and Patel et al, ( 28 ), with pathologist often relying wholly on histodiagnosis ( 4 , 28 ). Adeyi and Patel et al, in their studies suggested models for the improvement of histodiagnostic services in Africa including mentoring and collaboration with institutions in the developed world ( 4 , 28 ).…”