Accuracy of Clinical Suspicion and Pathologic Diagnosis of Kaposi Sarcoma in East Africa
Accuracy of Clinical Suspicion and Pathologic Diagnosis of Kaposi Sarcoma in East Africa
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DOI：
10.1097/qai.0000000000000862
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发表时间：
2016-03-01
影响因子：
3.6
通讯作者：
Martin, Jeffrey
中科院分区：
文献类型：
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作者：
Amerson, Erin;Woodruff, Carina Martin;Martin, Jeffrey
背景：与艾滋病毒相关的卡波西肉瘤（KS）是撒哈拉以南非洲地区最常见的恶性肿瘤之一。诊断通常基于临床怀疑，没有组织病理学证实。当进行活检时，当地病理学家解释的准确性知之甚少。我们评估了 2 个东非国家临床怀疑和病理诊断 KS 的准确性。方法：在乌干达和肯尼亚的 2 个大型 HIV 护理点，我们评估了 2008 年 10 月至 2013 年 1 月对临床疑似 KS 的 HIV 感染成人进行的连续活检。活组织检查由当地非洲病理学家和来自一个大容量医疗中心的一组美国皮肤病理学家进行了解读。出于本分析的目的，美国皮肤病理学家的解释被用作金标准。使用阳性预测值来表征非洲当地临床怀疑 KS 的准确性，并使用一致性、敏感性和特异性来表征当地病理诊断的准确性。 结果：在 1106 份活检中，临床怀疑 KS 的阳性预测值为 77%（95% 置信区间：74% 至 79%）。当 KS 未经组织病理学诊断时，35% 的患者发现临床上平庸的病症，59% 的患者发现需要不同治疗的医学上显着的疾病，6% 的患者发现危及生命的疾病。非洲病理学家和美国皮肤病理学家之间的一致性为 69%（95% 置信区间：66% 至 72%）。非洲病理诊断的敏感性和特异性分别为 68% 和 89%。 结论：在东非 HIV 感染者中，我们发现临床怀疑 KS 的阳性预测值和特异性但不敏感的组织病理学解释的阳性预测值不理想。研究结果呼吁放弃该地区孤立的 KS 临床诊断并加强当地皮肤病理学服务。
Background:HIV-associated Kaposi sarcoma (KS) is one of the most common malignancies in sub-Saharan Africa. The diagnosis is often based on clinical suspicion, without histopathologic confirmation. When biopsies are performed, the accuracy of interpretation by local pathologists is poorly understood. We assessed the accuracy of clinical suspicion and pathologic diagnosis of KS in 2 East African countries.Methods:At 2 large HIV care sites in Uganda and Kenya, we evaluated consecutive biopsies performed from October 2008 to January 2013 on HIV-infected adults with clinically suspected KS. Biopsies were interpreted by both local African pathologists and a group of US-based dermatopathologists from a high volume medical center. For the purpose of this analysis, the US-based dermatopathologist interpretation was used as the gold standard. Positive predictive value was used to characterize accuracy of local African clinical suspicion of KS, and concordance, sensitivity, and specificity were used to characterize accuracy of local pathologic diagnosis.Results:Among 1106 biopsies, the positive predictive value of clinical suspicion of KS was 77% (95% confidence interval: 74% to 79%). When KS was not histopathologically diagnosed, clinically banal conditions were found in 35%, medically significant disorders which required different therapy in 59% and life-threatening diseases in 6%. Concordance between African pathologists and US-based dermatopathologists was 69% (95% confidence interval: 66% to 72%). Sensitivity and specificity of African pathologic diagnoses were 68% and 89%, respectively.Conclusions:Among East African HIV-infected patients, we found suboptimal positive predictive value of clinical suspicion of KS and specific, but not sensitive, histopathologic interpretation. The findings call for abandonment of isolated clinical diagnosis of KS in the region and augmentation of local dermatopathologic services.