Feasibility of Fine-Needle Aspiration Biopsy and Rapid On-Site Evaluation for Immediate Triage in Breast Cancer Screening in Tanzania

Abstract

PURPOSE Clinical breast examination (CBE) is one of the most common methods used for early detection of breast cancer in low- and middle-income countries. CBE alone is limited by lack of specificity and may result in unnecessary diagnostic procedures. We evaluated the feasibility of integrating CBE, fine-needle aspiration biopsy (FNAB), and rapid on-site evaluation (ROSE) in triaging palpable breast masses for specialized cancer care. MATERIALS AND METHODS An intensive breast cancer screening event was conducted at a national trade fair by a multidisciplinary team of care providers targeting a healthy population in Dar es Salaam, Tanzania. All adults age ≥ 18 years were invited to participate. CBE was performed by oncologists and/or pathologists. FNAB was performed by a pathologist on palpable masses that were then categorized as benign, indeterminate, or suspicious for malignancy or definitively malignant based on ROSE. RESULTS A total of 208 individuals (207 females, one male; median age, 36 years; range, 18-68 years) were screened. Most (90.8%, 189 of 208) had normal findings, whereas 7.2% (15 of 208), 1% (2 of 208), and 1% (2 of 208) had a palpable mass, breast pain, and nipple discharge, respectively. Two participants had lesions too small for palpation-guided biopsy and clinically consistent with fibroadenomas; the participants were counseled, and observation was recommended. FNAB was performed on 13 breast masses, with 9 of 13 (69%) categorized as benign and 4 of 13 (31%) suspicious for malignancy. Final cytopathologic review of referred patients confirmed one case to be breast adenocarcinoma, one was suggestive of fibroadenoma, and two showed inflammations. CONCLUSION Integration of CBE with ROSE and FNAB was feasible in a breast cancer screening program in Tanzania. In settings with constrained resources for cancer care, this may be an effective method for triaging patients with breast masses.

Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries

“… 58 Godfrey in 2021 reported that in a setting with constrained resources for cancer care in Tanzania, integration of clinical breast examination of palpable lesions with FNAB, rapid on-site evaluation, and rapid PCR testing for estrogen receptor (ER) is feasible in a breast cancer screening program and may be an effective method for triaging patients with breast masses. 59 Similar recommendations have been released in India where early detection of breast lesions is mandated using clinical breast examination followed by ultrasound and FNAB cytopathologic triage. 60 , 61 A study conducted by Vohra et al supported the equivalency of ER and human epidermal growth factor receptor 2 evaluation performed on FNA cell blocks compared with surgical tissue blocks.…”

“…60 , 61 A study conducted by Vohra et al supported the equivalency of ER and human epidermal growth factor receptor 2 evaluation performed on FNA cell blocks compared with surgical tissue blocks. 62 The use of FNAB material for ER PCR analysis 59 has been demonstrated while using scraped material from direct smear material for hormone receptor analysis. Although this method is eminently technically feasible, it requires an advanced molecular pathology service.…”

“…The use of FNAB material for ER PCR analysis 59 has been demonstrated while using scraped material from direct smear material for hormone receptor analysis. Although this method is eminently technically feasible, it requires an advanced molecular pathology service.…”

Risk of Malignancy in Breast FNAB Categories, Classified According to the Newly Proposed International Academy of Cytology (IAC) Yokohama System

“… 13–15 However, it is apropos to reconsider the overall significance of FNAB for both developed and developing countries. 16 Therefore, in order to reaffirm the importance of FNAB as an economically viable diagnostic approach, we conducted a broad study to analyze ROM frequency in FNAB breast cases, categorized according to the new IAC Yokohama System. In our studies, we found that FNAB was highly sensitive and specific for malignant lesions, which supports its use as a cheap diagnostic technique in low- and middle-income countries.…”

Breast Cancer Early Detection in Eswatini: Evaluation of a Training Curriculum and Patient Receipt of Recommended Follow-Up Care

“… 11 In Kenya, Botswana, and Tanzania, at discrete BC screening events open to interested women, CBE yielded PPVs of 9%, 3%-4%, and 5%, respectively. 10 , 14 , 15 …”