Feasibility and cost effectiveness of using fine needle aspiration biopsies for the diagnosis of palpable breast masses in peripheral hospitals in Tanzania.

A prospective study to determine the feasibility and cost effectiveness of fine needle aspiration cytology (FNAC) was done in Ndanda and Morogoro (the peripheral hospitals) and Muhimbili the national referral hospital in Dar es Salaam, Tanzania. All patients with breast lumps) who presented at the surgical outpatient clinics) or surgical wards) in these three hospitals were studied from November 1993 to August 1995. Fine needle aspiration smears from peripheral hospitals, were posted to Muhimbili for staining and interpretation by the pathologist. The surgeons followed these patients with open tissue biopsies. For Muhimbili patients aspiration was done in the pathology cytology laboratory by the pathologist, whereas tissue biopsies were sent to the laboratory by the surgeons after operation. For both smears and tissue biopsies, dates of posting from peripheral hospital, receiving (taking in, in case of tissue biopsies) at the pathology laboratory, making diagnosis and getting cytology or histology report by the surgeon were noted by the author in each patient through collaboration with the surgeons. The mean number of days taken for each procedure was calculated from the day of aspiration or operation. A total of the 256 FNAC patients were studied, of these 206 (80.5%) were from Muhimbili, 41 (16.0%) from Morogoro and 9 (3.5%) were from Ndanda. Of the 256 FNAC patients, 86 (33.6%) had traceable tissue biopsies. Results showed that compared to tissue biopsies FNAC significantly reduced the mean number of days in posting, receiving specimens at the laboratory, making diagnosis and getting report. Seventy three (28.5%) patients who had adequate cytological material and had histological follow up, were analyzed to assess the accuracy of FNAC compared to histological diagnosis. FNAC was found to be a highly accurate method in diagnosis of palpable breast masses with an accuracy of 95.8%, sensitivity of 94.8% and specificity of 97.0%. Cost effectiveness analysis indicated that FNAC was highly cost effective, reducing the cost of diagnosing breast masses in peripheral hospitals by 63.3% and 60.2% for one outpatient and inpatient respectively. The respective cost reduction at Muhimbili referral hospital were 70.4% and 65.7% for one outpatient and inpatient. Therefore FNAC provides a rapid, accurate and cheap method of accurately diagnosing breast lumps. The findings of this study suggest that FNAC should be recommended for diagnosis of breast lumps in all hospitals in Tanzania.