Diagnostic accuracy of fine needle aspiration cytology for palpable breast lumps in a Nigerian teaching hospital.

BACKGROUND: Breast lump is a very common problem in the surgical units of many hospitals. Considering our unique socio-cultural and economic peculiarities, the ideal initial preoperative diagnostic tool for breast diseases should be cost-effective, simple with minimal physical and psychological trauma. AIMS: This study aimed to evaluate the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in the management of palpable breast lesions in our center. METHODSOLOGY: This is a prospective study that lasted for one year. Fine needle aspiration cytology was done after clinical examination of all patients who gave consent. Open surgical biopsy was used as a reference standard. RESULTS: One hundred and fifteen patients were enrolled. We found that unsatisfactory smears (C1) were seven (6.1%), benign smears (C2), 57 (49.6%), atypical smears (C3), five (4.3%), suspicious of malignancy smears (C4), six (5.2%) and unequivocally malignant smears (C5), 40 (34.8%). Fine needle aspiration cytology achieved high sensitivity (90.4%), specificity (93.7%), positive predictive value (92.2%), negative predictive value (92.2%) and overall diagnostic accuracy (92.2%) for breast lumps in this study. The false positive and negative rates of 7.8% each are both higher than values recommended by National Health Services Breast Screening Program (NHSBSP) of United Kingdom. CONCLUSION: In view of the high sensitivity, specificity and overall diagnostic accuracy combined with early retrieval of pathologic results on first clinic visit reported in this study, FNAC should become a useful tool in the management of breast lumps in our center.

Nosocomial infections and the challenges of control in developing countries

Nosocomial infection is a recognized public health problem world-wide with a prevalence rate of 3.0-20.7and an incidence rate of 5-10. It has become increasingly obvious that infections acquired in the hospital lead to increased morbidity and mortality which has added noticeably to economic burden. However; after about three decades of nosocomial infection surveillance and control world-wide; it still remains an important problem for hospitals today. Studies have shown that most hospitals in developing countries especially Africa; have no effective infection control programme due to lack of awareness of the problem; lack of personnel; poor water supply; erratic electricity supply; ineffective antibiotic policies with emergence of multiply antibiotic resistant microbes; poor laboratory backup; poor funding and non-adherence to safe practices by health workers. It is recommended that the cost of hospital infection control programme should be included in the health budget of the country and fund allocated for the infection control committee for routine control purposes and to bear the cost of outbreaks. There is need for adequate staffing and continuous education of staff on the principles of infection control; especially hand washing which is the single most important effective measure to reduce the risks of cross infection