Evaluation of Imprint Cytology of Endoscopic Gastric Mucosa Biopsy in the Diagnosis of Helicobacter pylori Infection

Background:Helicobacter pylori colonization of the gastric mucosa is associated with the pathogenesis of gastritis, peptic ulcer disease, and gastric malignancy. There are several methods to detect the presence of Helicobacter pylori.These tests include noninvasive method (serology, urea breath test, or stool antigen test) and invasive methods, such as, culture, histological examination, and rapid urease test. Method:This descriptive prospective cross sectional study was conducted in Gezira state in Wad Madeni from March - August 2016;it aimed to determine the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of imprint cytology in the detection of H. pylori compared with stool Ag test. H.pylori stool Ag test was done for 50 clinically suspected patients for H.pylori infection and one gastric biopsy from each patient was collected during endoscopy. Air-dried imprint smears of gastric biopsies were stained by the Diff-Quik method and examined for H.pylori. The presence of inflammation and intestinal metaplasia were documented. Results: The H. pylori prevalence was 38% by stool Ag test and 42% by imprint cytology. The sensitivity and specificity of imprint cytology in the detection of H. pylori were 89.5% and 87.1% respectively. The PPV and NPV were 80.1% and 93.1%, respectively. The accuracy of the test was 88.0%. Conclusion:This study concludes that gastric imprint smears stained with Diff-Quik method is a rapid, cheap, and reliable method for the detection of H.pylori infection.It recommends the use of Imprint cytology for detection of Helicobacter pylori inpatients undergoing upper gastrointestinal endoscopy

Immunohistochemistry defined subtypes of breast cancer in 678 Sudanese and Eritrean women; hospitals based case series

Abstract Background Breast cancer is the most common malignancy accounting for 25% of all cancers in females. In Africa, breast cancer prevalence and mortality are steadily increasing. Knowledge of hormone receptors and human epidermal growth factor receptor-2 (HER-2) expressions are vital for breast cancer management plans and decision making. There is wide regional variation in the proportion of these biomarkers, especially in African countries. Hormone receptors positivity in indigenous African and African American women is considered to be low and triple negative breast cancer is a dominant phenotype. There is paucity of data regarding hormone receptors (ER and PR) and HER2 expressions in North-eastern Africa (Eritrea and Sudan). The purpose of this study was to evaluate the expression of ER, PR and HER2 in Eritrean and Sudanese case series and correlate these biomarkers with the clinicopathological profile. Method Clinicopathologic data of patients were collected from clinical records. Immunohistochemistry biomarkers (ER, PR, and HER2) were assessed in consecutive female patients who had been diagnosed with invasive breast cancer from 2011 to 2015 in Gezira University Pathology Laboratory, the Sudan and National Health laboratory, Asmara, Eritrea. Results There were 678 cases involved in this study. The mean age was 48.8 years with ±0.53 standard error of the mean. Two-thirds of the case were ≤50 years. Invasive ductal carcinoma, no special type was the most dominant histologic type (86%) in both study groups. The majority of cases (70%) had tumour stage pT2 and pT3 and about 50% had lymph node involvement. Less than 5% of the cases had well-differentiated tumours. The ER, PR and HER2 positive rates were 45%, 32%, and 29%, respectively. The proportion of luminal-A like, luminal-B like, HER2 enriched and TNBC were 37%, 13%, 16% and 34%, respectively. Fisher extract analysis showed age (p = .015), tumour size (p = .041), and histologic grade (p = .000) were significantly associated with intrinsic subtypes. Furthermore, Logistic regression analysis stratified by origin, age, tumour size, lymph-node metastasis and grade indicated that younger women age (≤50 years) and grade III tumours were more likely to be diagnosed with ER negative breast cancer. Conclusion Most of Sudanese and Eritrean women were diagnosed at younger age and with unfavourable prognostic clinicopathologic prognostic markers. TNBC is more frequent in this cohort study; patients with grade III tumours and young age are more likely to be hormone receptors negative. Therefore, routine determination of hormone receptors is warranted for appropriate targeted therapy

Comparison of Receptor-Defined Breast Cancer Subtypes Between German and Sudanese Women: A Facility-Based Cohort Study

Purpose: The objective of this study was to compare tumor characteristics, biomarkers, and surrogate subtypes of breast cancer between Sudanese and German women. Methods: Tumor characteristics and immunohistochemistry markers (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]) were collected from the routine assessment of consecutive patients with invasive breast cancer diagnosed from 2010 to 2015 (Gezira University Pathology Laboratory, Gezira, Sudan) and from 1999 to 2013 (Breast Centre, Martin-Luther-University, Halle, Germany). Results: A total of 2,492 patients (German [n = 1,932] and Sudanese [n = 560]) were included. Age at diagnosis ranged from 20 to 94 years. Sudanese women were, on average, 10 years younger than German women, with a mean (± standard deviation) age of 48.8 (13.5) and 58.6 (12.4) years, respectively. The Sudanese women had a higher grade, larger tumor, and more lymph node positivity compared with German women. ER-, PR-, and HER2-negative proportions were 55%, 61.8%, and 71.3%, respectively, for Sudanese women versus 22.7%, 32.3%, and 82.5%, respectively, for German women. The triple-negative subtype was more prevalent in Sudanese women (34.5%) than in German women (14.2%). The strongest factor associated with ER-negative disease was grade III (odds ratio, 19.6; 95% CI 11.6 to 33.4; P < .001). Sudanese patients were at higher risk for ER-negative breast cancer, with an odds ratio of 2.01 (P = .001; adjusted for age, size, nodal status, histologic type, and grade). Stratified by grade, the influence of origin was observed in grade I and grade II tumors, but not in grade III tumors. Conclusion: Sudanese women had more aggressive tumor characteristics and unfavorable prognostic biomarkers. After adjustment, Sudanese origin was still associated with hormone receptor–negative disease, especially in grade I and II tumors. These findings suggest differences in tumor biology among these ethnic groups