Fine needle aspiration biopsy: diagnostic utility in resource-limited settings

Abstract

Little information is available on the value of fine needle aspiration biopsy (FNAB) in routine paediatric practice in resource-limited settings. To provide an overview of all paediatric FNAB samples received at Tygerberg Hospital, Cape Town, South Africa over a 3-year period, including the determinants of sample adequacy and the diagnoses. Samples were analysed from three locations: Tygerberg Hospital (TBH) where pathologists performed all the procedures, surrounding clinics where aspirates were mostly performed by doctors with no formal training in FNAB technique, and Queen Elizabeth Hospital, Blantyre, Malawi where FNABs were performed by trained nurse aspirators. A total of 830 aspirates were reviewed: 464 (56%) from TBH, 264 (32%) from local clinics and 102 (12%) from Blantyre. The main diagnoses at TBH were mycobacterial infection (31%), normal/reactive tissue (27%) and malignancy (14%); malignancy dominated (74%) in the select group from Blantyre. Sample adequacy rates were similar between pathologists and nurse aspirators [399/464 vs 82/102, odds ratio (OR) 1.4, 95% confidence interval (CI) 0.8-2.6]. Results were significantly better in the group who received formal training (TBH and Malawi) than in the clinics where clinicians had no formal training (481/566 vs 171/264, OR 3.1, 95% CI 2.2-4.4). FNAB provides a definitive tissue diagnosis in the majority of patients. Well-trained nurse aspirators perform as well as pathologists, indicating the feasibility of FNAB in resource-limited settings.