Accuracy of clinical suspicion and pathologic diagnosis of Kaposi sarcoma in East Africa

Erin Amerson, Carina Martin Woodruff, Amy Forrestel, Megan Wenger, Timothy McCalmont, Philip LeBoit, Toby Maurer, Miriam Laker-Oketta, Winnie Muyindike, Mwebesa Bwana, Nathan Buziba, Naftali Busakhala, Kara Wools-Kaloustian, Jeffrey Martin

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)295-301
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume71
Issue number3
DOIs
StatePublished - 2016

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Eastern Africa
Kaposi's Sarcoma
Biopsy
HIV
Confidence Intervals
Sensitivity and Specificity
HIV-2
Uganda
Africa South of the Sahara
Kenya

Keywords

  • Cancer
  • Dermatopathology
  • Diagnosis
  • Kaposi sarcoma
  • Pathology
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Amerson, E., Woodruff, C. M., Forrestel, A., Wenger, M., McCalmont, T., LeBoit, P., ... Martin, J. (2016). Accuracy of clinical suspicion and pathologic diagnosis of Kaposi sarcoma in East Africa. Journal of Acquired Immune Deficiency Syndromes, 71(3), 295-301. https://doi.org/10.1097/QAI.0000000000000862

Accuracy of clinical suspicion and pathologic diagnosis of Kaposi sarcoma in East Africa. / Amerson, Erin; Woodruff, Carina Martin; Forrestel, Amy; Wenger, Megan; McCalmont, Timothy; LeBoit, Philip; Maurer, Toby; Laker-Oketta, Miriam; Muyindike, Winnie; Bwana, Mwebesa; Buziba, Nathan; Busakhala, Naftali; Wools-Kaloustian, Kara; Martin, Jeffrey.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 71, No. 3, 2016, p. 295-301.

Research output: Contribution to journalArticle

Amerson, E, Woodruff, CM, Forrestel, A, Wenger, M, McCalmont, T, LeBoit, P, Maurer, T, Laker-Oketta, M, Muyindike, W, Bwana, M, Buziba, N, Busakhala, N, Wools-Kaloustian, K & Martin, J 2016, 'Accuracy of clinical suspicion and pathologic diagnosis of Kaposi sarcoma in East Africa', Journal of Acquired Immune Deficiency Syndromes, vol. 71, no. 3, pp. 295-301. https://doi.org/10.1097/QAI.0000000000000862
Amerson, Erin ; Woodruff, Carina Martin ; Forrestel, Amy ; Wenger, Megan ; McCalmont, Timothy ; LeBoit, Philip ; Maurer, Toby ; Laker-Oketta, Miriam ; Muyindike, Winnie ; Bwana, Mwebesa ; Buziba, Nathan ; Busakhala, Naftali ; Wools-Kaloustian, Kara ; Martin, Jeffrey. / Accuracy of clinical suspicion and pathologic diagnosis of Kaposi sarcoma in East Africa. In: Journal of Acquired Immune Deficiency Syndromes. 2016 ; Vol. 71, No. 3. pp. 295-301.
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abstract = "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.",
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AU - Woodruff, Carina Martin

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AU - Wenger, Megan

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AU - LeBoit, Philip

AU - Maurer, Toby

AU - Laker-Oketta, Miriam

AU - Muyindike, Winnie

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AU - Wools-Kaloustian, Kara

AU - Martin, Jeffrey

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N2 - 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.

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